Syphilis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

SYPHILIS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES N. P...

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SYPHILIS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Syphilis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84083-0 1. Syphilis-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on syphilis. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON SYPHILIS .................................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Syphilis ......................................................................................... 5 E-Journals: PubMed Central ....................................................................................................... 31 The National Library of Medicine: PubMed ................................................................................ 35 CHAPTER 2. NUTRITION AND SYPHILIS .......................................................................................... 79 Overview...................................................................................................................................... 79 Finding Nutrition Studies on Syphilis ........................................................................................ 79 Federal Resources on Nutrition ................................................................................................... 81 Additional Web Resources ........................................................................................................... 81 CHAPTER 3. ALTERNATIVE MEDICINE AND SYPHILIS .................................................................... 83 Overview...................................................................................................................................... 83 National Center for Complementary and Alternative Medicine.................................................. 83 Additional Web Resources ........................................................................................................... 85 General References ....................................................................................................................... 88 CHAPTER 4. DISSERTATIONS ON SYPHILIS ...................................................................................... 89 Overview...................................................................................................................................... 89 Dissertations on Syphilis ............................................................................................................. 89 Keeping Current .......................................................................................................................... 90 CHAPTER 5. CLINICAL TRIALS AND SYPHILIS................................................................................. 91 Overview...................................................................................................................................... 91 Recent Trials on Syphilis ............................................................................................................. 91 Keeping Current on Clinical Trials ............................................................................................. 92 CHAPTER 6. PATENTS ON SYPHILIS ................................................................................................. 95 Overview...................................................................................................................................... 95 Patents on Syphilis ...................................................................................................................... 95 Patent Applications on Syphilis................................................................................................. 111 Keeping Current ........................................................................................................................ 112 CHAPTER 7. BOOKS ON SYPHILIS .................................................................................................. 113 Overview.................................................................................................................................... 113 Book Summaries: Federal Agencies............................................................................................ 113 Book Summaries: Online Booksellers......................................................................................... 115 The National Library of Medicine Book Index ........................................................................... 118 Chapters on Syphilis .................................................................................................................. 119 CHAPTER 8. MULTIMEDIA ON SYPHILIS........................................................................................ 121 Overview.................................................................................................................................... 121 Video Recordings ....................................................................................................................... 121 Audio Recordings....................................................................................................................... 122 Bibliography: Multimedia on Syphilis ....................................................................................... 123 CHAPTER 9. PERIODICALS AND NEWS ON SYPHILIS..................................................................... 125 Overview.................................................................................................................................... 125 News Services and Press Releases.............................................................................................. 125 Newsletter Articles .................................................................................................................... 129 Academic Periodicals covering Syphilis..................................................................................... 130 CHAPTER 10. RESEARCHING MEDICATIONS................................................................................. 131 Overview.................................................................................................................................... 131 U.S. Pharmacopeia..................................................................................................................... 131 Commercial Databases ............................................................................................................... 132 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 137

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Overview.................................................................................................................................... 137 NIH Guidelines.......................................................................................................................... 137 NIH Databases........................................................................................................................... 139 Other Commercial Databases..................................................................................................... 143 APPENDIX B. PATIENT RESOURCES ............................................................................................... 145 Overview.................................................................................................................................... 145 Patient Guideline Sources.......................................................................................................... 145 Finding Associations.................................................................................................................. 153 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 155 Overview.................................................................................................................................... 155 Preparation................................................................................................................................. 155 Finding a Local Medical Library................................................................................................ 155 Medical Libraries in the U.S. and Canada ................................................................................. 155 ONLINE GLOSSARIES................................................................................................................ 161 Online Dictionary Directories ................................................................................................... 166 SYPHILIS DICTIONARY............................................................................................................. 167 INDEX .............................................................................................................................................. 221

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with syphilis is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about syphilis, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to syphilis, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on syphilis. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to syphilis, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on syphilis. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON SYPHILIS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on syphilis.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and syphilis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “syphilis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Otosyphilis in a Patient with Human Immunodeficiency Virus: Internal Auditory Canal Gumma Source: Otolaryngology: Head and Neck Surgery. 112(3): 488-492. March 1995. Summary: This article presents a case report of a patient with progressive bilateral (both sides) sensorineural hearing loss (SNHL) and new onset dysequilibrium (loss of balance). A 42-year-old man presented after he had subjective hearing loss and tinnitus with intermittent disequilibrium. At his initial visit, audiometric examination revealed moderately severe sensorineural hearing loss in the high frequencies of the left ear and a mild to moderate, mixed hearing loss in the right ear. Magnetic resonance imaging (MRI) revealed a left internal auditory canal (IAC) mass lesion, and he was initially thought to have an acoustic schwannoma. However, on further evaluation, he was found to be infected with syphilis and HIV. The authors diagnosed the patient with

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otosyphilis with a left IAC gumma. Surgery was canceled because of the high probability of infectious involvement. The patient was given a 3-week course of benzathine penicillin G, 2.4 million units per week by intramuscular injection, and began taking azidothymidine (AZT). After six weeks, the patient had significant improvement in hearing bilaterally. The most recent audiogram, obtained approximately six months after diagnosis and four months after treatment, was entirely within normal limits. Despite developing AIDS and later dying of HIV encephalopathy, the patient had no subsequent auditory or vestibular symptoms or sequelae. 2 figures. 23 references. (AA-M). •

Prevalence of Syphilis, Hepatitis B Virus (HBV), and Human Immunodeficiency Virus (HIV) Infection in New Arrestees at the Lake County Jail, Crown Point, Indiana Source: Journal of Prison & Jail Health; Vol. 12, no. 2, Winter 1993. Contact: Eli Lilly and Company, Eli Lilly Corporate Center, Indianapolis, IN, 46285, (317) 276-2000, http://www.lilly.com. Summary: This article reviews a study conducted to determine the prevalence in arrestees of syphilis, hepatitis B virus (HBV), and HIV infection by demographic and behavioral characteristics, and to evaluate the costs associated with universal screening for these sexually transmitted diseases compared with a theoretical targeted screening program. Three hundred and nineteen arrestees were screened for syphilis, HBV, and anonymously for HIV infection. The prevalence of syphilis was 2.5 percent; hepatitis B surface antigen prevalence was 1.6 percent; the prevalence of past or present HBV infection was 21.9 percent; and the prevalence of HIV infection was 1.6 percent. Targeted screening for sexually transmitted diseases was found to be more costeffective.

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Retrospective Study of Syphilis Seropositivity in a Cohort of Demented Patients Source: Alzheimer Disease and Associated Disorders. 7(1): 33-38. Spring 1993. Summary: This journal article describes a retrospective study that examined the rate of syphilis seropositivity in a sample of 376 patients with dementia. The mean age was 74 years and 73 percent were women. All patients had received medical, psychosocial, psychological, psychiatric, neurological, and laboratory evaluations. Diagnoses included Alzheimer's disease in 30 percent of the sample, vascular dementia in 25 percent, combined Alzheimer's disease and vascular dementia in 14 percent, and other diagnoses in 31 percent. The mean Mini Mental State Examination score was 16, indicating moderately advanced dementia. Fluorescent treponemal antibody absorption tests (FA), used to diagnose neurosyphilis, were performed in 338 of the patients and were reactive in 10.9 percent. Nine patients received both FA and rapid plasma reagin (RPR) tests. All had positive FA tests but only 2 had reactive RPR tests. 15 references.

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The Resurgence of Syphilis in the United States Source: Current Opinion in Infectious Diseases, 1991; Vol. 4. Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Prevention Services, Division of Sexually Transmitted Disease, 1600 Clifton Rd NE, Atlanta, GA, 30333, (404) 639-8002. Summary: This reprint of a journal article says that more cases of both primary and secondary syphilis were reported in 1989 than in any other year since 1949, and that the amount of infection is on the rise in spite of four decades of penicillin therapy. The

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rising incidence of drug use has been linked to the spread of the Sexually transmitted disease (STD). The article says that observations in patients coinfected with Human immunodeficiency virus (HIV) have raised questions about the adequacy of penicillin treatment. Efforts to control the epidemic have brought needed attention to improving health care delivery to persons at risk for syphilis. It examines the epidemiology of early syphilis infection, congenital syphilis, interventions, treatment, and the connection between syphilis and HIV.

Federally Funded Research on Syphilis The U.S. Government supports a variety of research studies relating to syphilis. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to syphilis. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore syphilis. The following is typical of the type of information found when searching the CRISP database for syphilis: •

Project Title: ADOLESCENTS TRANSMISSION

IN

THE

DRUG

CULTURE

AND

STD

Principal Investigator & Institution: Rothenberg, Richard B.; Professor; Family and Preventive Medicine; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 31-AUG-2003 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AIDS INTERNATIONAL TRAINING AND RESEARCH PROGRAM Principal Investigator & Institution: Johnson, Warren D.; Chief and Professor; Medicine; Weill Medical College of Cornell Univ New York, Ny 10021 Timing: Fiscal Year 2001; Project Start 21-SEP-1998; Project End 31-MAY-2003 Summary: The objective of this proposal is to build on previous successful collaborations between (Cornell) researchers from Weill Medical College of Cornell University (formerly known as Cornell University Medical College), the Haitian Study Group on Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), the Haitian Red Cross, and the Haitian Ministry of Health to develop a national blood safety program for Haiti, which may serve as a model for blood safety programs in other developing countries. Studies by Cornell-GHESKIO researchers in 1983, during the early stages of

2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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the HIV epidemic in Haiti, demonstrated that 40% of the HIV infected women in Portau-Prince had received a blood transfusion. Cornell-GHESKIO researchers identified a for-profit blood bank as a source of many of these transfusions. Based upon this information, the Haitian Ministry of Health closed the for-profit blood bank in 1986, and placed the Haitian Red Cross in charge of blood safety in Haiti. In 1988, with the assistance of a Fogarty training grant, Cornell-GHESKIO researchers trained the administration and technical staff of the Haitian Red Cross in blood safety testing. The Haitian Red Cross, with on-going technical advice from Cornell-GHESKIO researchers, continues to monitor blood safety in Port-au-Prince. The current proposal aims to solidify the training of the Haitian Red Cross in Port-au-Prince and to expand their activities to rural Haiti where 70% of the population lives. The highest priority will be given to the training of personnel directly involved in blood banking operations (laboratory technicians, counselors and data entry staff), as well as physicians who are most likely to use blood products (obstetricians and surgeons). In addition, the general public will be educated and encouraged to give regular blood donations and to avoid paid donors. The current proposal also aims to address several areas of research of importance for blood safety in Haiti: 1) determine the prevalence rate and risk factors for infection with blood borne pathogens among blood donors in urban and rural Haiti including HIV-1, HIV-2, HTLV-1, HCV, HBV, syphilis, and malaria; 2) determine the prevalence and risk factors among blood donors of HIV-infected individuals in the "window period", the time between HIV infection and development of HIV antibodies detectable by standard ELISA assays. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AN EDUCATIONAL INTERVENTION FOR OLDER CRACK USERS Principal Investigator & Institution: Johnson, Wendell A.; Family and Preventive Medicine; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-AUG-2003 Summary: (provided by applicant): This proposed planning initiative is designed to: 1) increase our understanding and knowledge of HIV risks factors which are specific to middle-aged and older African American male and female users of crack cocaine, and; 2) demonstrate the effectiveness of an age- specific outreach intervention designed to gain access to target group members, increase AIDS knowledge and health risk (e.g. HIV; STD) awareness, assist clients in assessing individual health risk, and promote drug free living. Utilizing a pre-post test intervention design, we will recruit and collect baseline data on three groups of persons: (1) middle aged and older sexually active men (aged >50) for whom crack cocaine is the primary drug of choice (n=40); (2) middle aged and older sexually active women (aged >50) for whom crack cocaine is the primary drug of choice (n=40), and; (3) sexual partners; individuals who have engaged in a sexual act with members in groups 1 or 2 (n=80). Serologic testing for HIV and syphilis, and urine or vaginal swab for testing gonorrhea and chlamydia will be conducted on all study participants. We will conduct one post intervention assessment (including biologic test) in month 9 with Groups 1 and 2 only. These data will be used to describe and compare demographic, serologic, and HIV risk characteristics of older crack cocaine users and their sexual partners; measure and evaluate intervention impact and exposure. In parallel with these quantitative assessments, the qualitative, ethnographic component will consistent of ongoing direct observation augmented by 2 ethnographic interviews per week during the first year of the study and subsequent diminution to 1 interview per week until the conclusion of the study or until redundancy is reached. The ethnographic interviews will be held with selected study participants, their contacts,

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and other key informants (e.g. landlords, shopkeepers, persons involved in drugs in these neighborhoods, etc.). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL ASPECTS OF VIRUS-HARBORING TRICHOMONAS VAGINALIS Principal Investigator & Institution: Piper, Jeanna M.; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2001 Summary: Human suffering and health care costs due to sequellae of STDs are escalating worldwide, including pelvic inflammatory disease, chronic pelvic pain, involuntarily infertility, and ectopic pregnancies. Project 5 will correlate clinical characteristics of T. vaginalis infections (including behavioral and demographic features as well as co-infections with other STD agents) with the presence or absence of dsRNA virus in T. vaginalis isolates. These two clinical T. vaginalis isolate types (i.e., with and without dsRNA virus) exist naturally and contribute to different outcomes in clinical demographic, and behavior parameters to be evaluated. Thus, as documented in Project 1, the virus provides a marker from which to carry out comparative clinical and adverse outcome studies. Specific Aim 1 perform a comprehensive evaluation of T. vaginalis isolates with an without dsRNA virus and relate these data to various clinical parameters by a) examining characteristics (genitourinary symptoms and physical findings) between vaginitis caused by virus-harboring and virus-minus isolates in pregnant and non-pregnant women, b) evaluating behaviors, demographic features and partner history associated with the two isolate types of T. vaginalis, and c) establishing linkages between infection with the two isolate types and other STD agents. Specific Aim 2 will evaluate the risk of adverse outcomes in women with STDs during pregnancy by a) examining infections by T. vaginalis with and without dsRNA virus and b) simultaneously examining and identifying other current infections (gonorrhea, chlamydia, bacterial vaginosis, group B, streptococcus, syphilis, HHV8, and M. genitalium). Specific Aim 3 will facilitate collaborations with the other four Projects by a) providing fresh clinical T. vaginalis isolates from patients with trichomonosis for Project #1, b) coordinating identification and follow-up of pregnant women with the HHV8 Project #2 by collecting maternal samples and pregnancy outcome data, c) providing clinical data dn specimens for the Mycoplasma genitalium Project 3, and d) providing clinical expertise and additional infection information to Behavioral Project 4. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CUTANEOUS IMMUNE RESPONSE IN EARLY SYPHILIS Principal Investigator & Institution: Radolf, Justin D.; Director/ Professor; Ctr for Microbial Pathogenesis; University of Connecticut Sch of Med/Dnt Bb20, Mc 2806 Farmington, Ct 060302806 Timing: Fiscal Year 2001; Project Start 01-APR-1996; Project End 31-MAY-2006 Summary: (Applicant's Abstract): Venereal syphilis is a chronic inflammatory disorder driven by the persistence of its etiologic agent Treponema pallidum. Research in this proposal is based on the premise that the local (i.e., tissue-based) cellular immune responses to T. pallidum have two distinct, yet interrelated, consequences of fundamental importance to syphilis pathogenesis. They cause the tissue damage which ultimately gives rise to clinical manifestations, and they are primarily responsible for the clearance of bacteria, a prerequisite for lesion resolution. Human skin is the primary

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focus of our efforts to elucidate these processes because (a) it is the major target organ of early syphilitic infection, (b) it is easily accessible to in vivo experimentation, and (c) there exists a wealth of reagents and information concerning its immune-related functions. During the prior funding interval, we have made considerable progress in characterizing the cellular infiltrates in secondary syphilis lesions and in delineating the ontogeny of the cutaneous response engendered by the syphilis spirochete. A unifying theme of this work has been the acquisition of considerable evidence, using a combination of in vitro and in vivo approaches, to support our primary hypothesis that the proinflammatory properties of treponemal lipoproteins are the primary triggers of innate immune mechanisms in early syphilis. More recently, we have shown that by recruiting a cellular infiltrate rich in antigen presenting cells, particularly dendritic cells, and memory/effector T cells, the innate immune processes induced by these lipidmodified polypeptides set the stage for the adaptive (i.e., specific) immune responses to the bacterium. One important outcome of these findings is the recognition that the cutaneous responses under investigation relate to primary as well as to secondary syphilis. In this competitive renewal application, we will extend this conceptual framework by further characterizing the in vivo biological responses to treponemal lipoproteins/lipopeptides (Aim One); by further characterizing the cutaneous immune response to T pallidum in secondary syphilis lesions (Aim Two); by using in vitro/ex vivo approaches to examine dendritic and T cell responses to T pallidum and treponemal proteins (Aim Three); and by examining our hypothesis that treponemal lipoproteins activate macrophages following uptake and degradation within the phagosomal vacuoles of macrophages (Aim Four). This work will result in an enhanced appreciation of the role of local cellular responses in syphilis pathogenesis and will provide a necessary underpinning for the eventual development of a safe and effective syphilis vaccine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DENDRITIC CELLS IN THE IMMUNOPATHOGENESIS OF SYPHILIS Principal Investigator & Institution: Norgard, M V.; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2001; Project Start 01-JUN-1997; Project End 31-MAY-2006 Summary: Syphilis, a chronic, complex sexually transmitted disease of humans caused by the spirochetal bacterium Treponema pallidum, remains a global public health problems. Although the immunology of syphilis is complex, clinical manifestations in all stages of syphilis derive principally from cell-mediated processes that are "triggered" by T. pallidum as it invades and replicates with genital skin. The actual cell type than initiates this early immune response thus far has not been identified. Over the past decade, overwhelming evidence suggests that dendritic cells (DCs) (e.g. Langerhans cells [LCs] of the epidermis and dermal dendritic cells [DDCs] are crucial for the initiation of primary T cell responses to foreign antigens. The working hypothesis for this second-year continuation application is that DCS likely serve as the pivotal immune effector cells that initiate the cellular inflammatory response during syphilis. Thus far, DCs in the cellular immune responses to T. pallidum have not been studied. Accordingly, the Specific Aims of this project have been (1) to characterize the interaction(s) of virulent T. pallidum with DCs, with emphasis on examining phagocytic processes, (2) To assess DC activation and/or maturation following exposure of immature DCs to T. pallidum or its constituent pro-inflammatory membrane lipoproteins, and (3) To examine whether tissue migration is induced following

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9

exposure of DCs to T. pallidum or its membrane lipoproteins (longer range goal). Much progress already has been made over the last eight months towards accomplishing Specific Aims 1 and 2, utilizing two immortalized murine DC lines, XS52 and XS 106, developed and provided by Dr. Akira Takashima of the U.T. Southwestern Skin Disease Research Center. In Specific Aim 3; we will employ human skin organ cultures to examine T. pallidum- or lipoprotein-induced DC migration and activation. This study is likely to yield important new insights into the role(s) of DCS as key effector cells in the immunopathogenesis of syphilis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DOUCHING AND REPRODUCTIVE TRACT INFECTIONS Principal Investigator & Institution: Funkhouser, Ellen M.; Epidemiology & Interntl Health; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAY-2004 Summary: Douching is a common practice among American women, especially in the South, among Black women, and among women who are less educated. Douching has been associated with many adverse health events including pelvic inflammatory disease and ectopic pregnancy, and to a much less well established degree, sexually transmitted diseases (STDs). The proposed project is a cross-sectional study of reproductive tract infections and douching practices in Jefferson County, AL. Women attending the County STD clinic and 2 County Family Planning Clinics will be interviewed prior to examination regarding douching practices and history of sexual activities, pregnancies, contraceptive practices, and STDs. Presence of infections and pH of vaginal secretions will be ascertained from appropriate tests. Cases will be women presenting with syphilis, gonorrhea, trichomonas, chlamydia , or bacterial vaginosis. Over a 29 month period 4,370 women, 1,400 from the STD clinic and 2,970 from the Family Planning Clinics, will be interviewed. This should provide about 935 STD cases, 577 cases of bacterial vaginosis without an STD, and 2,858 women with no infections. Douching practices among women with and without a reproductive tract infections will be compared. Logistic regression analysis will be used to assess the following: 1) whether douching is associated with increased risks of STDs or bacterial vaginosis; 2) whether douching is associated with vaginal pH; 3) whether there is a dose-response relationship regarding frequency of douching; and 4) whether the risk differs according to preparation used. We believe the similarities in socioeconomic status of women attending the clinics will be substantial making douching practices potentially one of the most distinguishing characteristics of women with and without an infection. Furthermore, the findings will be readily generalizable to a population that historically and currently has some of the highest STD rates in the nation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DRUG COUNSELING

ABUSE,

DEPRESSION

AND

RESPONSES

TO

HIV

Principal Investigator & Institution: Marmor, Michael; Environmental Medicine; New York University School of Medicine 550 1St Ave New York, Ny 10016 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2005 Summary: (provided by applicant) The long-term objective of this research is to reduce the incidence of infection with human immunodeficiency virus type 1 (HIV) in industrialized countries by developing methods to identify and treat high-risk individuals whose response to HIV testing and counseling is hindered by

10

Syphilis

psychopathology. The project's specific aims are (1) to describe the distribution of psychopathologies among persons undergoing HIV testing and counseling, and (2) to test the hypotheses that high-risk, HIV-seronegative persons with mild-to-moderate depression will be more likely to adopt protective behavior changes when provided with pharmacotherapy for their depression than when treated with placebo. The study design to achieve specific aim 2 will be a randomized, double-blinded clinical trial of bupropion hydrochloride versus placebo administered for a total of 7 months. The study population will be initially high-risk, HIV-seronegative men who have sex with men (MSM). Individuals who are ineligible or decline entry into the clinical trial will be entered into an observational study. The primary outcome measure of the clinical trial will be self-reported numbers of partners in unprotected receptive anal intercourse. Secondary outcomes will be substances used and frequency of substance use by selfreport and toxicology; (c) new infections with sexually transmitted infections including gonorrhea, syphilis, Kaposi's sarcoma-associated herpesvirus, and hepatitis C virus (HCV) and HIV; and (d) measures of psychological factors that have been shown to be, or are thought to be, associated with HIV incidence rates, including measures of selfefficacy, self-esteem, stage of change, and depression. Enrollment data from the observational study will be combined with enrollment data from the clinical trial to provide a description of the distribution of psychopathologies and substance abuse among high-risk MSM. Longitudinal data form the observational study will be used to assess the associations of psychopathologies, substances used and frequency of substance use with adverse outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ECONOMIC IMPACT OF HIV PREVENTION ON STDS Principal Investigator & Institution: Johnson-Masotti, Ana P.; Assistant Professor; Psychiatry and Behavioral Med; Medical College of Wisconsin Po Box26509 Milwaukee, Wi 532264801 Timing: Fiscal Year 2001; Project Start 01-AUG-2000; Project End 31-JUL-2003 Summary: Sexual risk reduction interventions to prevent the transmission of HIV also have beneficial effects on other social health concerns, such as non-HIV STDS and unintended pregnancy. Most prior studies of the cost-effectiveness of HIV prevention interventions focus only on the impact of the intervention on HIV outcomes. Studies that neglect the impact of these interventions on other STDs and unintended pregnancies may underestimate the economic benefits of sexual behavior change. Furthermore, little is known regarding the cost-effectiveness of HIV prevention interventions viewed as STD (or unintended pregnancy) prevention programs. This application seeks funding to conduct a cost-effectiveness analysis of a community-level sexual behavior risk reduction intervention that was implemented at multiple locations in the U.S. The intervention targets low-income, predominantly African- American adolescents living in urban housing developments. This analysis will allow us to: 1) estimate the number of HIV and STD infections and the number of unintended pregnancies prevented by the intervention, as well as associated savings in medical care costs and lost economic productivity; 2) evaluate the cost-effectiveness of the intervention with regard to HIV (measured by the cost per HIV case averted), STDs (measured by the cost per chlamydia, gonorrhea, syphilis, HPV, or HBV case averted), and unintended pregnancies (measured by the cost per unintended pregnancy prevented); 3) compare the cost-effectiveness of this intervention with other HIV, STD, and unintended pregnancy prevention interventions; and 4) determine how much difference the addition of non-HIV STDs and unintended pregnancy outcomes make to

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the estimated HIV prevention cost-effectiveness of the intervention. The proposed, more inclusive, approach to estimating the cost-effectiveness of HIV prevention should produce more accurate estimate for use in policy analyses and resource allocation decision-making. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EMPOWERING WOMEN DRUG USERS TO REDUCE HIV RISK Principal Investigator & Institution: Gollub, Erica L.; Psychiatry; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 20-JUN-2001; Project End 31-MAY-2004 Summary: (provided by applicant): Despite more than 15 years of behavioral intervention research seeking to reduce HIV risk behaviors among drug-using persons, drug-using women, across drug categories, remain at very high risk of HIV infection through unsafe sex. Available epidemiological data suggest that women drug users are at the highest risk of HIV infection relative to other risk groups in the US. State-of-theart HIV counseling and testing (CT) prevention approaches are insufficient to address women's risk. The proposed project uses a woman-specific prevention approach, already tested for feasibility and short-term behavior change on diverse cultural groups. The intervention (BESTBET) seeks to respond to the public health emergency among drug-using women by addressing the concrete realities of economic and emotional dependence on an often-risky sex partner, which provide the foundation of women's HIV risk. Based on Body Empowerment Theory, the proposed intervention provides interactive, skills-based learning, and offers a range of new protection technologies to women, including the female condom. Guided by an Advisory Board of national experts on drug-using women, and sexual behavior, the study seeks to empower women by creating a sense of control over one's body and health, increased community and peer support for new norms, and greater usage of healthful community resources (drug -related, medical, social). Group intervention sessions lead by trained "near-peer" counselors will focus on risk-reduction for sexual and drug-related HIV risk, and on combined drug-sex risk behavior. This 3-year, randomized controlled trial will recruit 240 out-of-treatment drug-using women in West Philadelphia. Both arms will first receive an enhanced HIV CT module composed of 2 short individualized counseling sessions. The study will test the effects of adding a multiple-group session model administered over 5 weeks, with 2 boosters, in the form of 'reunion sessions," against a control condition receiving only the CT module. Follow-up assessments for behavioral outcomes (via audio-assisted computer interview) and biological/serological outcomes (incidence of gonorrhea, Chlamydia and Trichomonas, HIV and syphilis) will occur at 6month intervals over 12 months. Treatment of incident infections will provide for valid measures of STD incidence. A strong relationship with community organizations will be sought, including: community input into the study throughout, training of community group leaders in study techniques and technologies, the distribution of women's "sexual risk reduction kits," and adoption of study activities by community groups by the time of study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EPIDEMIOLOGY Principal Investigator & Institution: Zheng, Xiwen; Natl Ctr for Aids Prevention and Control Prevention and Control (Ncaids) Beijing, Timing: Fiscal Year 2002; Project Start 01-DEC-2001; Project End 30-NOV-2006

12

Syphilis

Summary: The purpose of the Epidemiology Project (Project 1) is to establish HIV incidence and risk factors for HIV infection in three regions of China in order to establish a foundation for conducting clinical trials of HIV prevention and therapeutic interventions. The three specific aims of Project 1 are: Aim 1: To estimate the prevalence and incidence of HIV-1 infection and selected sexually transmitted diseases over time in: a) former plasma donors (FPDs), their stable sexual partners, and their children in rural areas of Shanxi province; b) injection drug users (IDUs) and their stable sexual partners in rural areas of Yunnan Province; and c) female sex workers (FSWs) in Kunming, Yunnan Province; Aim 2: To determine risk factors for HIV infection in the above population, and to recruit participants from these populations for participation in cohort studies in preparation for vaccine, behavioral and therapeutic intervention studies; and Aim 3: TO estimate the prevalence and incidence of HIV-1 infection, HHV8 infection and co-infection with HIV-1 and HHV8 in high risk minority population in Xinjiang Province, and to determine factors that are independently associated with co- infection with HIV-1 and HHV8. Strategies for recruitment and retention of study subjects will vary by study populations. About 1680 FPDs and 900 spouses will be recruited from 12 villages in Shanxi. About 600 HIV-FPDs or HIV-spouses will be followed in year 3 and 5. About 960 IDUs and 400 spouses will be recruited from 48 villages in Yunnan. About 504 HIV-IDUs and some 250 HIV-spouse will be followed at 6, 12, 18, 24 and 30 months after baseline. About 1000 FSWs will be recruited in hotels, entertainment establishments, and in the streets of Kunming City, Yunnan. FSWs will e followed for 2 years with 3 months interval contract and 6-month interval for assessment. About 250 subjects each will be recruited from Kelkez, Kazak, Ughur and Han ethnic groups and followed annually in Urumi, Xinjiang Four biologic indicators (HIV, gonorrhea, chlamydia, and syphilis) will be used cross all 4 study populations. HHV8 will be additionally used in study of minorities in Xinjiang. Our FPD and IDU studies will provide a subject of subjects (HIV positive) for the behavioral intervention study planned in Project 2. In collaboration with Project 4, we will seek to provide clinical care for HIV infected persons identified over the course of recruitment. We will provide clinical specimens for key research initiatives described in Projects 3 and 4. Planning for field trials or candidate HIV vaccines will link Projects 1 and 5. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EXPRESSION AND FUNCTION OF MSP HOMOLOGUES IN T PALLIDUM Principal Investigator & Institution: Centurion-Lara, Arturo; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001 Summary: As primary syphilis resolves, most treponemes are cleared from the chancre. However, a few organisms escape the immune response to cause secondary syphilis and ultimately to establish chronic infection. May theories have been proposed to explain Treponema pallidum's capacity for immune evasion, yet none has convincing experimental support. Antigen variation is one of the most intriguing theories, but not candidate antigens have been identified until now. The recent identification of a polymorphic multicopy gene family in T. pallidum that encodes for proteins with predicated amino acid homology to the major sheath protein (msp) of Treponema denticola provides a family of likely candidates. We call these T. pallidum proteins the msp-homologues. The broad goal of this proposal is to determine the cellular location and the function of the msp-homologue proteins. The specific aims of the project are the following: 1. Determine whether msp-homologues are surface exposed antigens in T.

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pallidum Nichols strain. This aim will test the hypothesis that some of the msphomologues are surface exposed in living organisms. 2. Determine whether msphomologues are involved in cell attachment and function as porins. This aim will determine whether the msp-homologue family has a role in two well-recognized mechanisms of pathogenesis of bacterial infections. 3. Determine whether T. pallidum Nichols strain represents a colonal bacterial population or is comprised of subpopulations of treponemes. This aim will test the hypothesis that, like other spirochetes, T. pallidum strains contain subpopulations that express heterogeneous msp- homologues. 4. Determine whether the msp-homologues undergo antigen variation or phase variation. Antigenic variation is common other pathogenic treponemes and the msp-homologue gene family has characteristics highly suggestive of genetic recombination and reassortment. This aim will test the hypothesis that individual msp-homologues either change (antigenic variation) or are no longer expressed (phase variation) during the course of infection. The studies proposed in this application will define the role of the msp- homologues in immune evasion and in the pathogenesis of syphilis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PALLIDUM

EXTRACELLULAR

MATRIX

ADHESINS

OF

TREPONEMA

Principal Investigator & Institution: Cameron, Caroline E.; Assistant Professor; Medicine; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2002; Project Start 15-APR-2002; Project End 31-MAR-2006 Summary: (Provided by the applicant): Syphilis, caused by the spirochete bacterium Treponema pallidum subsp. pallidum, is a chronic bacterial infection that remains a public health concern worldwide, with an estimated 12 million new cases reported in developing nations, Eastern Europe, and the Southern United States. In the absence of appropriate antibiotic treatment, T. pallidum establishes a lifelong chronic infection that may progress to the debilitating and potentially fatal tertiary disease in approximately one third of infected individuals. Apart from the serious nature of the disease itself, a number of studies suggest syphilis infections may increase the risk of acquisition and transmission of human immunodeficiency virus. The first step in establishing a T. pallidum infection is bacterial attachment and colonization of epithelial surfaces. Consequently, a logical approach for preventing T. pallidum infection is to develop methodologies for inhibiting bacterial attachment to host cells. The studies outlined in this proposal focus upon the identification of T. pallidum adhesins involved in host cell attachment, and specifically those involved in attaching to components of the extracellular matrix (ECM). The adhesins of T. pallidum will be identified using a variety of experimental techniques, including affinity chromatography and expression library screening. Putative adhesins will be expressed in a recombinant form using heterologous expression systems. These proteins will subsequently be investigated for their involvement in host cell attachment by determining their binding potential to host cells and ECM components. Confirmed adhesins will be tested for their ability to complement the non-adherent treponeme T. phagedenis biotype Reiter, and the molecular regions of the treponemal adhesins and ECM components responsible for attachment will be identified. The T. pallidum adhesins will also be analyzed for their immunoprotective potential in rabbit immunization and challenge experiments, and specifically for their ability to prevent treponemal infection. The long-term objective of the studies outlined in this proposal is to identify T. pallidum ECM-adhesins, which will

14

Syphilis

in turn help to further our under-standing of the molecules involved in T. pallidum pathogenesis and identify potential syphilis vaccine candidates. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AMERICANS

GENETIC

TESTING/HEARING

IMPAIRMENT

IN

AFRICAN

Principal Investigator & Institution: Robin, Nathaniel H.; Associate Professor; Genetics; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant) African Americans (AA) as a group distrust the medical establishment. The reasons have been discussed in editorials and opinion papers, and include unfortunate historical events like the Tuskegee syphilis study and the Sickle Cell screening program. One undesirable consequence of this mistrust is that AA as a group have been hesitant to participate in biomedical research studies. Consequently, many medical advances have not had a direct benefit for this population. One example of this is the genetic basis for hearing impairment (HI). Over 60 hearingrelated genes have been identified in the past decade, and genetic testing is now available for one, GJB2. Studies among populations of Northern European extraction have shown that GJB2 mutations cause about 55% of nonsyndromic HI. No similar discovery has occurred for AA, as in limited studies GJB2 mutations have not been seen in AAs. Therefore, despite the many discoveries, there has been little advance in the genetics of HI in AA. A recent report suggested that mutations in a related gene, GJA1, may be more common in deaf/hard of hearing (D/HOH) AA, but this study was limited, as only 26 D/HOH AA were tested. In this proposal, we will examine the interrelated issues of AA's willingness to participate in research and the genetic basis of HI in AA. We will survey D/HOH AA and their families on their attitudes towards research and genetic testing for HI. Those subjects that complete the survey will then be offered free research-based genetic testing for several HI-related genes, GJB2, GJB6, and GJAI. Dr. Richard Smith at the University of Iowa will do the genetic testing. Offering the research based genetic testing will yield two valuable results. First, we will gain insight into why some AAs are unwilling to participate in research by comparing the results of those that agree to participate and those that decline. Second, by the results of the genetic testing, we will determine the frequency of mutations in GJB2, GJB6, and GJA1 among D/HOH AA. Subjects will be notified of their test results and offered free genetic counseling to have the results explained. From these results we will gain insight into why AA will/will not participate in research studies, and into their attitudes toward genetic testing for HI. Furthermore, these results will determine the role of mutations in GJB2, GJB6, and GJA1 in HI in AA. Together, these results will lead to more efficient genetic testing for HI in this population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GORDON CONFERENCE--BIOLOGY OF THE SPIROCHETES Principal Investigator & Institution: Weis, Janis J.; Professor; Gordon Research Conferences Box 984, 512 Liberty Ln West Kingston, Ri 02892 Timing: Fiscal Year 2002; Project Start 01-JAN-2002; Project End 31-DEC-2002 Summary: The fifth Gordon Research Conference on the Biology of Spirochetes will be held in January 2002 in Ventura, California. The Biology of Spirochetes Conference is unique. This is the only ongoing international meeting devoted to discussions on basic research of all medically important and biologically relevant spirochetes, a unique

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group of Eubacteria. Many spirochetes are pathogens and cause a variety of diseases, including syphilis, Lyme disease, relapsing fever, leptospirosis, periodontal disease, digital dermatitis of cattle, and swine and human dysentery. Historically, spirochetes have been difficult to study. These bacteria often have fastidious nutritional requirements and some have yet to be successfully cultured in vitro. Methods for genetic manipulation and mutational analysis of several spirochete species do not exist. The opportunity for exchange of ideas among groups working on different spirochetes has been one of the greatest benefits of past conferences, particularly in the area of new techniques for genetic manipulation. The application of genetic advancements and the availability of genomic sequences of Borrelia burgdorferi, Treponema pallidum, T. denticola, and new sequencing projects in Leptospira spp, are proving a wealth of new information. Combined, these data are being integrated into ongoing studies on the physiology, structure, pathogenesis, and immunobiology of these bacteria. Each of the previous Biology of Spirochetes conferences have been highly successful, receiving high praise by attendees, forging new collaborations, providing a forum for presenting stateof-the-art research on these bacteria, and helping to set new research directions. As in previous conferences, we expect attendance at the 2002 conference to reach the maximum of 150 faculty, graduate students, postdoctoral fellows, and industrial scientists. A broad spectrum of scientists representing different research interests, geographic locations, and seniority will be invited to attend. Special efforts will be made to insure strong attendance of young investigators (graduate students, post-docs and junior faculty), and achieve a balance in gender and ethnicity of attendees. The oral and poster-presentations are organized to provide many opportunities for discussion, the exchange of ideas, and development of collaborations. Funding from the National Institutes of Health is requested to partially offset the travel and registration expenses of the participating graduate students, fellows, and junior faculty members. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HIV AND THE SEXUAL NETWORKS OF IDUS AND DRUG-USING MSM Principal Investigator & Institution: Ouellet, Lawrence J.; Epidemiology and Biostatistics; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 30-JUN-2008 Summary: (provided by applicant): Preventing the sexual transmission of HIV is essential if the United States is to further reduce HIV incidence. Among drug-using populations, however, the sexual transmission of HIV is understudied. The proposed five-year study focuses on injection drug users (IDUs) and drug-using men who have sex with men (MSM) to examine the sexual diffusion of HIV within and across drugusing population subgroups and to non-drug using and non-MSM populations. Our approach combines 1) behavioral epidemiology, 2) two-types of social network analyses with strong geographic mapping components [including the ability to link geographic location with local socio-economic and health data], 3) mathematical modeling, and 4) and biologic testing for HIV, hepatitis B (HBV) and C (HCV), syphilis, chlamydia and gonorrhea. The study proposes a cross sectional survey of 2500 IDUs and about 562 of their non-injecting sex partners, and 3000 MSM and about 450 of their female sex partners. Participants will be recruited through respondent-driven sampling (RDS) [1-3] at six racially and ethnically diverse sites across Chicago. As a feature of RDS, sampling weights will be calculated to adjust for unequal probabilities of selection based on variations in network size, strength of in-group affiliation and recruitment effectiveness, and the data will be post-stratified so the results can be generalized to the population of

16

Syphilis

IDUs and drug-using MSM. HIV specimens from participants with newly diagnosed infections will be tested using the serologic testing algorithm for recent HIV seroconversion (STARHS), and HIV incidence computed from the results. HIV genotyping and phenotyping, RNA viral load testing, and cellular immune panels will be used to characterize newly diagnosed infections by drug resistance, infectiousness, and immune system suppression. Test results for other STIs will be used to better characterize the potential for future diffusion of HIV or increased vulnerability to infection with HIV. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RECRUITS

HIV/AIDS

PREVENTION

AMONG

ANGOLAN

MILITARY

Principal Investigator & Institution: Bing, Eric G.; Director, Collaborative Alcohol; None; Charles R. Drew University of Med & Sci 1621 E 120Th St Los Angeles, Ca 90059 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-AUG-2006 Summary: (Provided by applicant): HIV/AIDS has had a devastating impact on subSaharan Africa. With just 8 percent of the world's population, sub-Saharan Africa accounts for 70 percent of all the world's 36.1 million HIV/AIDS cases. Despite the high HIV prevalence rates of as much as 35 percent in neighboring countries, the reported HIV prevalence rate for Angola is reported to be only 3 percent. This relatively low rate may be due to the on-going civil war that has restricted population mobility. Therefore, there is at present a window of opportunity to save Angola from the devastation that AIDS has wrought on other areas of the sub-continent. Our international team of Angolan and American researchers proposes to test the effectiveness of a multi-session HIV/STD prevention intervention on reducing high-risk sexual behaviors and the incidence of sexually transmitted diseases among Angolan military recruits. Our 3 specific aims are: (1) To test the effectiveness of a cognitive-behaviorally focused intervention designed to reduce high-risk sexual behaviors and the incidence of STDs (such as HIV, chlamydia, gonorrhea, and syphilis) immediately following and at 3 and 6 months post-intervention; (2) To determine the degree to which the individual components of the intervention (information about HIV/STDs, motivation to reduce risk of infection, and skills at condom use) produce a reduction in high-risk sexual behaviors and the incidence of STDS; and, (3) To determine if predisposing factors such as sociodemographic and personal characteristics, psychiatric symptoms and disorders, alcohol use and history of STDs moderate the effect of the intervention on sexual risk taking and STD incidence. We will conduct the intervention in the Cabinda Province of Angola. Though Cabinda is the smallest Angolan province, 45 percent of all the country's AIDS cases have been reported there. To better understand the context of HIV prevention for the Angolan military, in Phase 1 we will conduct 5 focus groups with new recruits (2 groups), experienced soldiers, military sergeants, and HIV-positive soldiers. We will use the information gained in the focus groups to modify the content of the instruments to be used in a survey and the proposed intervention. In Phase 2, we will pilot test the survey instrument with 100 soldiers as well as the intervention. The proposed intervention, Salva Vida (Save Life), will consist of 4 sessions (1 session each week) and 1 booster session 6 weeks after the final session. In Phase 3, we will test the intervention with a total of 400 military men, with 200 being assigned to the intervention and 200 to the control condition, which will have a general health promotion focus. If this intervention is effective among military recruits in Angola, it may have applicability to many developing nations throughout the world battling HIV with scarce resources and little hope of treatment.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HIV/STD RISK BEHAVIORS IN METHAMPHETAMINE USER NETWORKS Principal Investigator & Institution: Shoptaw, Steven; Associate Research Psychologist; Psychiatry; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 30-JUN-2008 Summary: (provided by applicant): The proposed study will launch a multidisciplinary effort to examine the diffusion of HIV and sexually transmitted diseases (STDs including gonorrhea, chlamydia, and syphilis) in drug users in L.A. County to identify the individual level factors, partner-level factors, and environmental factors that promote the spread of these diseases. L.A. County is the second largest epicenter of AIDS cases in the nation, yet injection drug use (IDU) accounts for only a minority (13%) of cases, while the majority of cases involve MSM (70%). Recent, disproportionate increases of HIV infection for women and people of color in L.A. County imply the virus is moving from relatively contained groups into larger segments. This 5-year study proposes to establish a representative cohort of individuals thought to represent the behavioral "bridges" for these pathogens to enter the larger population: drug using MSM (n=240), drug using MSM/W (n=240) a comparison group of non-drug using MSM/W (n=240), and the male (n=288) and female (n=192) sexual partners of these individuals (total=1,200). Assessments will be collected at baseline, 6- and 12-months after enrollment. Data collected will address these study aims: (1) Measure associations between drug involvement (methamphetamine user, other drug user, non-drug user), IDU status, sexual risk behavior (MSM, MSM/W, WSM), and HIV/STDs; (2) Evaluate the types of sexual partnerships and dynamics of the partnerships of these individuals and how these are associated with HIV/STD transmission; and (3) Apply mathematical models to the data on partnerships to study how the incidence of HIV/STDs reflect the size and interconnectedness of the sexual networks of each of the groups and to determine the impact of sexual network structure in future transmission of HIV in L.A. within and beyond MSM and heterosexual drug using groups. The study will use methods of behavioral epidemiology, ethnography, viral analysis of HIV, and mathematical modeling to yield a comprehensive set of information to predict the spread of HIV and STDs from sexual networks of high HIV prevalence (drug using MSM) to those of low prevalence (heterosexuals). Outcomes from the proposed cohort study of IDU and non-lDU methamphetamine-using MSM and MSM/W and their sexual partners should provide evidence to guide policy and prevention efforts in response to the spread of HIV and STDs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IMMUNE MECHANISMS IN EXPERIMENTAL SYPHILIS Principal Investigator & Institution: Lovett, Michael A.; Professor of Genetics; Medicine; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2001; Project Start 01-JUN-1978; Project End 31-JAN-2005 Summary: To study the role of the rare T. pallidum (Tp) outer membrane (OM) spanning proteins in pathogenesis and immunity, we isolated Tp OM vesicles (OMV). OMV porin activity resides in a 31 kDa protein, Tromb1. Native Tromp1 is 31, 510 Da, and is processed from a 33,571 Da precursor. While native Tromp1 is hydrophobic, and

18

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trimeric, urea creates a hydrophilic monomer, indicating that the hydrophobicity of the native protein is conformationally determined. Monomeric rTromp1 has no poring activity and is hydrophilic. Renatured rTromp1 is trimeric and hydrophobic, with porin activity like native Tromp1. Renatured rTromp1 formed intra membranous particles in proteoliposomes. OMV were used to generated mouse antiserum that showed a 100% killing endpoint titer 32 times greater than time of immune rabbit serum (IRS). The OMV ant- serum bound Tromp1, Tromp2, and four lipoproteins were fully removed, while Tromp antibodies remained. The adsorbed serum showed no reduction in its high-titered treponemicidal activity, suggesting that Tromp1 and/or Tromp2 are the targets of this activity. Treponemicidal activity greater than that found in IRS has never previously been demonstrated. Our specific aims are therefore: 1. Determine the significance and basis of OMV induced treponemicidal antibodies. We will learn if OMV can convey protection in experimental syphilis. The possibility that treponemicidal antibodies. We will learn if OMV can covey protection in experimental syphilis. The possibility that there are relevant OMV proteins other than Tromp1 and 2 will be rigorously considered. The role of OMV in pathogenesis will be addressed by use of adherence and invasion assays. 2. Determine the role of Tromp1 in pathogenesis and immunity. Mass spectrometry adapted to nanogram amounts will be used to insure that rTromp1 faithfully duplicates the primary structure of native Tromp1. The ability of renatured rTromp1 and native Tromp1 to induce treponemicidal antibodies and protective immunity will be assessed, along with the role of Tromp1 in pathogenesis. 3. Determine the role of Tromp2 in pathogenesis and immunity. Tromp2 has conformationally determined hydrophobicity, but lacks porin activity. Tromp2 is considerably less abundant than Tromp1. Definitive determination of the primary structure of mature Tromp2 will be used as the basis for creating a rTromp2 whose primary structure is identical to the native protein. rTromp2 will be renatured and studied as outlined for rTromp1. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPACT OF SOCIAL NETWORKS ON SYPHILIS TRANSMISSION Principal Investigator & Institution: Rompalo, Anne M.; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2005 Summary: (Adapted from the Applicant's Abstract): The investigators propose to examine the role of social context and social influence on syphilis transmission in Baltimore. Currently, Baltimore has the Nation's highest rates for newly acquired primary and secondary syphilis. The goals of this study are, first, to examine the social context of syphilis risk through the assessment of social and sexual network characteristics. In collaboration with he Baltimore City Health Department (BCHD), the investigators will recruit between 400 and 1200 patients who present to the BCHD Sexually transmitted Diseases (STD) clinics for evaluation and treatment of primary and/or secondary stage syphilis. The investigators will collect specimens from these patients' syphilis lesions for restriction fragment length polymorphism (RFLP) analysis, and conduct social and sexual network interviews with these syphilis patients and their social/sexual network members. Using Geographic Information System (GIS), the investigators will map the social and sexual networks. This will allow us to track and compare possible syphilis transmission through both network types and to examine social structural factors, especially drug use, which may be associated with disease transmission and risk behaviors. Social context data will be confirmed by biologicallybased strain typing. The investigators propose to apply the RFLP technique in

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collaboration with Dr. Sheila Lukehart at the University of Washington to determine the prevalence of and factors associated with genetic clustering of syphilis in Baltimore over time. The investigators will determine if different RFLP profiles exist m Baltimore, use GIS to plot their spatial distribution and evaluate the relationship of social networks to clusters of infections. This will be the first time that a biological marker of transmission will serve to validate epidemiological defined transmission groups and thus improve our ability to delineate the sexual, social and personal network characteristics associated with syphilis transmission. The investigators are currently funded to examine the role of social context on gonorrhea transmission. As a second goal of this study will be to compare the social context of syphilis risk to that of gonorrhea risk and to determine and compare the role of drug use and other social factors in the social context of both sexually transmitted diseases. Thus, the investigators propose to compare the efficacy of detecting early infectious (primary and secondary stage) syphilis cases by interviewing and screening social network members of early syphilis index cases compared to that of standard sexual partner notification techniques. The proposed project seeks five years of support to map, analyze and compare syphilis cases within social and sexual networks. Data collected in this proposal data may be applied to modify current methods of syphilis contact tracing and develop more effective future preventive and intervention strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INCREASING PARTICIPATION OF MINORITY RESEARCHERS IN ETH Principal Investigator & Institution: Sander, Linda D.; Pediatrics; Meharry Medical College 1005-D B Todd Blvd Nashville, Tn 37208 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-AUG-2004 Summary: The media exposure of the Tuskegee Syphilis Experiments in 1974, and rare but well-publicized reports of research subjects' deaths, have contributed to mistrust by the public, and in particular minorities, of human subjects research and researchers. Efforts to overcome barriers of mistrust among minorities and medically underserved individuals are needed, so that the expectation of respectful medical care, and the benefits and altruistic satisfaction that may accompany human subjects research, may be shared more justly. Accordingly, recognition has grown in recent years of the importance of understanding the needs, interests, and perspectives about ethical research among individuals belonging to minority and medically underserved populations. To participate in this aim, Meharry Medical College, an historically black institution committed to the education and service of minority and underserved populations, has established the Program in Clinical and Research Ethics. This program addresses the need for increased minority involvement and leadership in clinical research ethics. Expertise and dialogue in research ethics are sought among Meharry's professional and student communities, as well as local community members and neighboring institutions. Collaboration with Vanderbilt University Medical Center and the New Orleans District FDA (serving Nashville) facilitates the exchange of ideas among professional communities. This collaborative arrangement serves both to help increase the interests and expertise of minority medical professionals in research ethics, and to increase the awareness among all human subjects researchers of the ethical needs of minority and underserved research subjects. Two main venues for research ethics education are offered. 1. For active researchers, IRB members, community members and students, we offer symposia on ethical issues in human subjects research. 2.

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For senior medical students and others, an innovative month long clinical elective in Clinical and Research Ethics is offered twice a year. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: 'LYME DISEASE: A POSSIBLE TEST FOR CURE Principal Investigator & Institution: Philipp, Mario T.; Chairman; None; Tulane University of Louisiana New Orleans, La New Orleans, La 70112 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 30-MAY-2004 Summary: (provided by applicant): It would be immensely useful for the management of Lyme disease (LD) treatment to have available a test for cure. Such a test could be employed not only to ascertain if treatment of acute LD was successful, thereby preventing the transition to the chronic, more intractable form of the disease, but also to distinguish among the possible etiologies of the so-called post-treatment LD syndrome. The PI and coworkers recently developed a sensitive and specific enzyme-linked immunosorbent assay (ELISA) for the serological diagnosis of LD. The test is based on the detection of antibody (Ab) to an immunodominant, invariable region (lR) of the lipoprotein VIsE. VIsE is the molecule that undergoes antigenic variation in Borrelia hurgdorfen (the etiologic agent of LD). A peptide (C6) representing the invariable region 6 (IR6) of VIsE serves as antigen. It is hypothesized that, because the spirochete should not simultaneously express on its surface more than one (or a few) VIsE variant(s) at any time, the VIsE lipoprotein must be rapidly turned over and degraded by the spirochete as new variants are progressively expressed. As a consequence of this postulated intrinsic instability, VIsE should be scarce on dead or dying spirochetes, and secondary Ab responses to the C6 peptide should decline in unison with the infection's demise, following antibiotic treatment. It is further hypothesized that the decline in titer of the C6 Ab as a function of time after treatment may serve as a test for Lyme disease cure. Preliminary results indicate that the C6 ELISA titer in cured patients falls by a factor greater or equal than 4 whereas for treatment-resistant patients the fall is by a factor <4. This is similar to the VDRL test used to diagnose syphilis cure.The broad, long-term objective of this project is to assess both retrospectively and prospectively the ability of the C6 ELISA to serve as a test for LD cure. In this proposal the C6 test will be assessed retrospectively by achieving three specific aims: Specific Aim 1: To assess retrospectively the C6 ELISA as a test for cure in patients with acute LD. Serial serum samples from patients with either erythema migrans ( n = 90) and/or culture-confirmed infection ( n = 156) will have been collected at presentation and at 6 and 12 months thereafter. The samples will be titrated for anti-C6 Ab. Specific Aim 2: To assess retrospectively the C6 ELISA as a test for cure in patients with chronic LD and posttreatment LD syndrome. Same as for SAl, but with patients with chronic LD (n = 150) and post-treatment LD syndrome (n = 60). Specific Aim 3: To assess the C6 ELISA as a test for cure in animal models of LD. Cure of LD will be assessed objectively (by culture and PCR) both in rhesus monkeys (chronic LD) and in mice (acute LD). Correlation between LD cure and anti-C6 Ab titers will be evaluated. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MEMBRANE PROTEINS OF TREPONEMA PALLIDUM Principal Investigator & Institution: Norgard, Michael V.; Professor; Microbiology; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2001; Project Start 01-MAY-1980; Project End 30-APR-2005

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Summary: Syphilis is a chronic, complex sexually transmitted disease caused by the spirochetal bacterium Treponema pallidum. That syphilis remains an alarming global public health problem and is a cofactor for the transmission of HIV underscore the importance of continued studies to elucidate its complex pathogenesis. Such studies are requisite for the development of a syphilis vaccine, an important element of the syphilis eradication initiative. Given that the membrane system of T. pallidum serves as both the physical and functional interface with the host, studies to elucidate the structure, function, and immunology of T. pallidum membrane proteins continue to be essential for the future design of novel syphilis intervention strategies. To this end, the Specific Aims of this proposal are: (1) To refine and implement a new chemotaxis assay for T. pallidum, with emphasis on elucidating potential chemoattractants that may facilitate tissue dissemination by T. pallidum; (2) To assess whether the Mg1B lipoprotein of T. pallidum is a receptor for glucose, the principal carbon and energy source for T. pallidum; (3) To assess the putative role in sensory transduction of Mcp1 and three other methyl-accepting chemotaxis proteins of T. pallidum; (4) To implement a new combined genome- and invasin-based strategy to identify T. pallidum rare outer membrane proteins that may qualify as syphilis vaccine candidates; and (5) To continue to investigate mechanisms by which T. pallidum and its proinflammatory lipoproteins facilitate HIV transmission, with emphasis on examining the upregulation of CCR5, the HIV-1 coreceptor, on T. pallidum-activated immune cells. The pursuit of these aims will further our understanding of T. pallidum membrane biology relevant to syphilis pathogenesis, tissue dissemination, and vaccine development, as well as delineate the molecular constituents which induce salient inflammatory processes that culminate in clinical disease. The aims also seek to advance new strategies for utilizing surrogate genetic systems for T. pallidum, such as E. coli and T. denticola, as a means of elucidating the interrelationship between T. pallidum membrane biology and syphilis pathogenesis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOLECULAR ANALYSIS OF TREPONEMAL MOTILITY GENES Principal Investigator & Institution: Limberger, Ronald J.; Director; Wadsworth Center Empire State Plaza Albany, Ny 12237 Timing: Fiscal Year 2001; Project Start 01-JUL-1993; Project End 30-NOV-2002 Summary: (Adapted from the Applicant's Abstract): Spirochetes are a diverse group of helical and planar wave-shaped bacteria having a unique structure and mode of motility. Spirochetes are the causative agents of syphilis (Treponema pallidum) and Lyme disease (Borrelia burgdorferi) and are associated with periodontal disease (Treponema denticola). The periplasmic location of the flagellar filament, together with the cell shape, enables the spirochete to move through dense matrices that would inhibit most other bacteria and assists in pathogenesis. This proposal involves determining the function of motility-associated polypeptides, development and analysis of mutants altered in motility to determine gene regulatory mechanisms, and assessment of the virulence capabilities of motility mutants. Treponema denticola will be used as a model for treponemal motility because it possesses newly identified tools for genetic analysis. The first polypeptide encoded by the fla motility operon, Tap1, has no known homologs but the investigators hypothesize it is involved in motility. This hypothesis will be tested using targeted mutagenesis to inactivate tap1 to observe the effect on cell movement together with immune electron microscopy to determine cellular location. Analysis of transcription of a polar flgE mutant suggests that T. denticola also has a unique system for regulation of motility gene expression. To test this hypothesis, targeted non-polar

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mutations will be made in motility-associated genes of specific classes, including the flagellar switch (fliG), hook (flgE), and regulation (fliA). Cytoplasmic filaments are a major component of treponemal cells with unknown function. A T. denticola mutant that lacks cytoplasmic filaments was constructed by insertional inactivation and these cells possess altered motility in liquid media and reduced colony diameter on 0.5% agarose-NOS plates. They hypothesize that the treponemal cytoplasmic filaments play a role in motility either directly through interaction with the periplasmic flagellum or indirectly through maintenance of cell structure. Biochemical analysis and tomography, together with the analysis of the cfpA-interrupted mutants will ascertain the role of this major cellular polypeptide. Finally, the involvement of motility in the virulence capabilities of T. denticola will be assessed in a murine abscess model using the specific motility mutants. The broad long-term objective is to understand the structure, function and regulation of treponemal motility-associated polypeptides and to assess their role in pathogenesis. Understanding the relationship of motility and cell structure to spirochete pathogenesis will result in development of therapeutics targeted towards inhibition of spirochete motility for prevention of human disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOLECULAR IMMUNOLOGY OF SYPHILIS Principal Investigator & Institution: Lukehart, Sheila A.; Professor; Medicine; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 30-SEP-1993; Project End 31-JUL-2004 Summary: Syphilis continues to be a major health problem in the United States and in the developing world. In addition to serious individual health risks due to untreated infection, syphilis is a co-factor for acquisition and transmission of human immunodeficiency virus infection. Recently, a new gene family was discovered in Treponema pallidum. The proteins encoded by these genes have homology to the major sheath protein (msp) of a related spirochete, T. denticola. Their predicated structure contains conserved. Preliminary studies strong support this hypothesis, and demonstrate that this proteins are central to the pathogenesis of syphilis and to immunity to infection. This gene family and its encoded proteins are the focus of the studies proposed in this application. The broad objectives of this Program Project are the following: 1. To explore the mechanisms of persistence of T. pallidum in the infected host via antigenic variation or phase variation. 2. To understand the immune response during syphilis and to explore the influence of that immune response on the expression of antigens by T. pallidum. 3. To define the antigens that can confer protective immunity to syphilis infection. Each of the three projects contained in this application will address one or more of these objectives in complementary ways. This proposed program is an outgrowth of cooperative and synergistic research on syphilis that has been carried out in the University of Washington over the past decade. It integrates the expertise of molecular biologists, immunologists, and clinicians in the examination of exciting, newly identified genes and molecules of Treponema pallidum that hold promise for explaining a number of the unsolved mysteries of syphilis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MOLECULAR STUDIES OF T PALLIDUM TPRJ, TPRG, AND TPRE GENES Principal Investigator & Institution: Stamm, Lola V.; Associate Professor; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599

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Timing: Fiscal Year 2001 Summary: Treponema pallidum is the etiologic agent of syphilis, a multistage sexually transmitted disease that is a global health problem. Identification of virulence determinants and protective immunogens of T. pallidum has been hindered by the noncultivable nature of this spirochete. Although T. pallidum has a cellular architecture similar to Gram negative bacteria, its outer membrane contains rare, poorly immunogenic proteins whose identified and functions remain elusive. Using TnphoA mutagenesis, we identified a gene (tprJ) encoding a protein with homology to the major surface protein of T. denticola, a periodontal pathogen. The tprJ is a member of a polymorphic multi-gene family encoding 12 proteins (TprA- L), that are divided into three subgroups. Recent studies have shown heterogeneity in the subgroup 3 (tprJ, tprE, and tprG) genes. We hypothesize that functional activities such as attachment, invasion, etc. The long-term goal of our studies is to develop a better understanding of variation of the subgroup 3 tpr genes and their corresponding proteins. The specific aims for the project are: (1) To detect nucleotide sequence variations within or flanking the tprJ, tprE, and tprG genes of T. pallidum obtained a various timepoints from chances of intradermally infected rabbits; (2) To examine expression of the TprJ, TprE and TprG proteins in T. pallidum and to assess the kinetics of the rabbit IgG antibodies to the TprJ, TprE and TprG proteins and to peptides representing the variable and/or conserved regions of the Tpr proteins; (4) To determine if immunization of rabbits with the TprJ, TprE, and TprG proteins of peptide protects against infection with T. pallidum and/or selects for phenotypic variants and (5) To evaluate nucleotide sequence variability of the tprJ, tprE, and tprG genes of T. pallidum in clinical specimens from syphilis patients attending local STD clinics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ONCOGENIC HUMAN PAPILLOMAVIRUSES & PROSTATE CANCER RISK Principal Investigator & Institution: Stanford, Janet L.; Head, Prostate Cancer Research Program; Fred Hutchinson Cancer Research Center Box 19024, 1100 Fairview Ave N Seattle, Wa 98109 Timing: Fiscal Year 2001; Project Start 10-SEP-2001; Project End 31-AUG-2003 Summary: Prostate cancer is the most frequent cause of cancer in men, yet few risk factors for this disease have been identified. Some prior studies suggest that sexual behavior and associated exposure to sexually transmitted agents enhance risk In particular, number of sexual partners, age at first intercourse, sexual frequency, history of gonorrhea and syphilis, and serologic evidence of syphilis and oncogenic subtypes of human papillomavirus (HPV) have been associated with risk of prostate cancer, but results have not been confirmed. In a recent study of risk factors for prostate cancer in men under age 65 years, we found a significant increase in risk with increasing number of female sexual partners (trend p <0.001), which we hypothesize is related to prior exposure to I-IPV-16 or -18. To test this hypothesis, we propose a population-based casecontrol study that will analyze stored serum from histologically confirmed prostate cancer cases (n=648) diagnosed during 1993-1996 and ascertained by the Seattle-Puget Sound SEER registry and from control men (n--571) without a history of prostate cancer and frequency matched on age to cancer cases. Virus-like particle ELISA serologic assays will be used to detect BPV-16 and -18. Detailed data on known and suspected risk factors for prostate cancer will be available from in-person interviews. Unconditional logistic regression will be used to estimate relative risks associated with HPV- 16/-18 infection, controlling for potential confounding factors. Clinical data on prostate cancer

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cases will be utilized to assess whether associations with HPV differ according to disease aggressiveness. Results from this study will provide insight on whether or not these oncogenic HPV subtypes play a role in prostate cancer etiology. If there is an association, the results will have important public health implications since both the exposure and the disease are common. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PERSISTENCE OF CNS T. PALLIDUM IN HIV INFECTION Principal Investigator & Institution: Marra, Christina M.; Associate Professor; Neurology; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2002; Project Start 30-SEP-1996; Project End 31-AUG-2004 Summary: (provided by applicant): The overall goal of our original proposal was to test the hypothesis that concomitant HIV-1 infection impairs clearance of Treponema pallidum from the CSF. The progress that we have made in the first funding period supports our hypothesis. Specifically, individuals with more pronounced HIV-1mediated immunosuppression are more likely to have neurosyphillis, and normalization of CSF WBC count and serum RPR after treatment for neurosyphilis is slower and less complete in HIV-1-infected individuals. Few studies have addressed the influence of concomitant HIV-1 on CNS infection by T. pallidum. In our study to date, we have enrolled and obtained CSF from 348 subjects with all stages of syphilis. Approximately three-quarters of our subjects are also HIV-1-infected. To date, 53 subjects have had at least one follow-uplumbar puncture. Our ongoing study represents the largest investigation of neurosyphilis in many decades, and is the only study with sufficient power to address the effect of concurrent HIV-1-infection on development of neurosyphilis and the response to neurosyphilis therapy in HIV-1-infected and uninfected individuals. In this competing renewal application, we focus on three clinically important questions. These questions and the principal hypotheses to be tested for each are: 1) Which HIV-1-infected and -uninfected patients with syphilis should undergo lumbar puncture to evaluate the possibility of neurosyphilis? We hypothesize that individuals with higher concentrations of T. pallidum in blood, those with particular strain types in blood and those with greater diversity of blood T. pallidum strains will be more likely to have neurosyphilis. We will test these hypotheses in Specific Aim 1; 2) How can CSF pleocytosis due to infection with T. pallidum be distinguished from CSF pleocytosis due to HIV-1 infection? We hypothesize that the CSF cellular phenotype and that production of T. pallidum-specific antibody by CSF lymphocytes will distinguish T. pallidum-induced from HIV-1-induced CSF pleocytosis. We will test these hypotheses in Specific Aim 2; and 3) What factors determine response to therapy in HIV-1-infected and -uninfected patients with neurosyphilis? We hypothesize that rapidity and completeness of response to treatment will be related to CSF T. pallidum concentration and to CSF T. pallidum strain type. We will test these hypotheses in Specific Aim 3. The studies proposed in this application are directly relevant to the care of patients with HIV-1 and with syphilis and will ultimately improve our ability to diagnose and treat neurosyphilis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PET ENCEPHALOPATHY

AND

MRI

IMAGING

OF

PERSISTENT

LYME

Principal Investigator & Institution: Fallon, Brian A.; Associate Professor of Clinical Psychiat; Psychiatry; Columbia University Health Sciences New York, Ny 10032

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Timing: Fiscal Year 2001; Project Start 08-DEC-1999; Project End 30-NOV-2003 Summary: This project tests specific hypotheses about functional and structural brain abnormalities in patients with Persistent Lyme Encephalopathy (PLE) and it cvaluates the efficacy of 10 weeks of IV ceftriaxone among patients previously treated with shorter courses of Iv antibiotics. Prior planar rCBF and SPECT studies of PLE reveal diffuse deficits affecting cortical and subcortical areas, primarily the white matter. These scans are often interpreted as consistent with vasculitis, multi-infarct dementia, or Lyme Disease. MRI series demonstrate that between 20-400/o of patients have hyperintensities, suggestive of inadequate arteriolar perftision resulting in demyelination and gliosis. To understand better the significance of these imaging abnormalities, this project will employ MRI and PET imaging and cognitive testing: a) to examine whether the functional imaging deficits are primarily vascular or metabolic in nature; b) to evaluate whether time course of improvement in MRI and PET scans correlates with clinical cognitive improvement; c) to identify whether deficits in blood flow (CBF), cerebral metabolism (CMR), and extent of MRI hyperintensities have prognostic significance; and d) to determine whether a subgroup of patients with poor outcome PLE have impaired vascular reserve 60 patients with PLE and 20 matched controls will be studied over 4 years. A second major goal is to determine the efficacy of a 10 week placebo-controlled trial of IV ceftriaxone in PLE using objective behavioral and imaging measures. After treatment, patients will be monitored off antibiotics to week 24. Durability of response will be examined by cognitive retesting at wk 48. Imaging procedures include MRI (T1 sagittal, 3D volumetric, T2 spin echo, FLAIR, and magnetization transfer sequences), O15. H2O PET during rest and hypercapnia, and FDG PET assessment of resting rCMR. We will test specific hypotheses about reversible and fixed functional and structural abnormalities that may account for antibiotic responsive and -unresponsive PLE. These hypotheses derive from histopathological studies indicating that a subgroup of patients with PLE have evidence of a vasculitic process that may lead to a syphilis-like endarteritis obliterans, with impairment in hcmodynamic reserve. This study will enhance our understanding of the pathophysiology and treatment of patients suffering with the disabling effects of persistent Lyme encephalopathy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHYSIOLOGIC CHARACTERISTICS OF TREPONEMA PALLIDUM Principal Investigator & Institution: Norris, Steven J.; Professor and Vice Chair for Research; Pathology and Lab Medicine; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225 Timing: Fiscal Year 2001; Project Start 01-MAY-2001; Project End 30-APR-2005 Summary: (Provided by applicant): The complete sequence of the Treponema pallidum subsp. pallidum genome was determined in 1998 providing a new window to the physiology of this enigmatic organism. Availability of the annotated sequence represents a major advance in syphilis research. However, sequence information can only serve to predict function, and functional analysis is a necessary step in the practical application of this data to syphilis prevention and control. This application represents a reactivation of a project aimed at determining the nutritional and environmenta requirements of T. pallidum and applying this information toward the in vitro culture and improve understanding of the pathogenesis of syphilis. Specific Aim 1 will focus on the metabolic pathways predicted b, the sequence and the application of this information to the in vitro culture of T. pallidum. Both cell-free and tissue-culture systems will be utilized to assess the effects of medium components on T. pallidum

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survival multiplication, and DNA replication and damage. Specific Aim 2 will address the relationship between 7 pallidum and oxygen, which is key to its survival and growth. The central hypothesis addressed in this Aim i that NADH oxidase and the multimeric protein AhpC play a major role both in maintaining a proper red-o' environment in the cell and in removing reactive oxygen intermediates. In Specific Aim 3, Dr. Milton Saier an colleagues at the University of California at San Diego will examine the role of the phosphoenolpyruvate dependent phospho-transferase system (PTS) in gene regulation. A unique aspect of the T. pallidum genome i that it encodes HPr (PtsH), the HPr(ser) kinase (PtsK), a frameshifted Enzyme I (PtsI) and two additiona potential regulatory PTS proteins, but no recognizable sugar-specific PTS permeases. The likelihood that the existing PTS components are involved in a regulatory network independent of transport function will b investigated. It is anticipated that the results of this study will improve understanding of the growth requirements, oxygen utilization, and regulatory systems of T. pallidum. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROTECTIVE IMMUNITY AGAINST SYPHILIS Principal Investigator & Institution: Van Voorhis, Wesley C.; Associate Professor; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001 Summary: Syphilis is a major public health problem in parts of the US and in the developing world. A vaccine to prevent syphilis is urgently needed. Treponema pallidum subsp. Pallidum, the spirochete that causes syphilis, has 12 polymorphic genes that encode proteins with homology to the major sheath protein (msp) of Treponema denticola. In preliminary experiments, immunization with T. p. pallidum. Nichols strain msp-homologue recombinant proteins was partially protective against challenge with T. p. pallidum Nichols strain. The overall goal of this research is to use msp-homologues to develop a protective vaccine against T. p. pallidum infection. The specific aims of this project are the following: 1. Test the ability of immunization with msp- homologues to protect the challenge with T.p. pallidum Nichols strain. This aim will test the hypothesis that immunizing with msp-homologues of T.p. pallidum Nichols strain will lead to protection against challenge with Nichols strain. Immunization using the variable and constant domains will be compared, as will immunization with multiple versus single msp homologues. 2. Determine the heterogeneity of msp-homologue genes in other strains of T.p. pallidum The RFLPs of the4 variable domains of msp- homologue genes are different from strain to strain. In this aim, the variable domains of different strains will be compared by sequence analysis. 3. Test the ability of immunization with msp-homologues to protect from infection with multiple strains of T.p. pallidum. We hypothesize that strain heterogeneity of msp-homologues explain the lack of cross-protection after infection with heterologous strains. The protective capacity of Nichols strain msp-homologues will be compared with heterologous and Nichols strain challenge. As the diversity of msp-homologues among the strains is understood, a multivalent immunization with msp-homologues will be devised to provide protection against challenge with multiple strains. 4. Test alterative vaccine strategies for protection against T.p. pallidum. This aim will test the hypothesis that delivery of msp-homologues via alternative strategies targeting mucosal and CD8/class I immunity will improve protection against challenge with T.p. pallidum. The results of these studies will lead to an understanding of the mechanisms of protective immunity in syphilis and ultimately lead to a vaccination strategy to prevent syphilis.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STDS, FERTILITY, MARRIAGE AND DEMOGRAPHIC PROJECTION Principal Investigator & Institution: Gray, Ronald H.; Faculty; Population & Family Hlth Scis; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 19-MAR-2001; Project End 28-FEB-2003 Summary: STDs and HIV reduce fertility and increase pregnancy loss. Sub-fertility may lead to marital instability and dissolution, resulting in increased high risk sexual behaviors and thus enhanced M/MV risk. HIV testing also places stress on marriages. We propose to use a unique data set from a community-based study in rural Rakai District, Uganda. Data are available for 11,315 women and 10,698 men who provided detailed socio-demographic, health and behavioral information, and samples for STD diagnosis, at 5 home visits conducted at 10-month intervals (40 months follow up). These panel data will be used to address the following specific aims using an instrumental variable approach and fixed-effects models to control for endogeneity and unobserved heterogeneity. 1) Among women at risk of conception, we will estimate the effects of HIV and other STDs on pregnancy and pregnancy loss rates in HIV+ and HIVwomen, with or without other STDS, after adjustment for covariates such as age, marital status, sub-fertility, frequency of intercourse, contraception and knowledge of HIV status. 2) Longitudinal analyses will be used to assess the effects of prevalent HIV/STD infections, reduced fertility and HIV testing/counseling on family planning use (condom /other modem methods) and rates of marital dissolution, subsequent sexual behaviors and STD/HIV acquisition. Data on couples and sexual networks will also be considered. 3) Reduced fertility of HIV+ women causes bias in antenatal surveillance of HIV, leading to underestimation of population HIV prevalence and artifacts in HIV trends. We will estimate the magnitude of this bias in HIV prevalence estimates among pregnant women relative to the population of reproductive age, and assess how such bias varies by age, parity, duration of marriage, and over time. Demographic projections of the impact of the HIV epidemic are largely based on antenatal HIV seroprevalence estimates and fail to account for the fertility inhibiting effects of HIV. In collaboration with the U.S. Bureau of Census, data from the proposed study will be used to revise demographic projections of the effects of HIV on population growth, composition and AIDS orphanhood. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: STRUCTURE-FUNCTION STUDIES OF FLAGELLAR ROTOR COMPONENTS Principal Investigator & Institution: Blair, David F.; Associate Professor; Biology; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2004 Summary: Many of bacteria swim by rotating helical filaments that act as propellers. This motility is a factor in the virulence of many bacterial pathogens, including those that cause ulcers, syphilis, burn wound infections, and some diarrhea. Each filament is driven by rotary motor in the cell membrane; the filament/motor structure is called a flagellum. The energy for rotation comes from the membrane iron gradient. Like any rotary motor, the bacterial flagellar motor possesses a stator (the non-rotating part) and a rotor (the rotating part). FliG, FliN, and FliM are three proteins that function in a complex on the rotor. Recently, x-ray crystallography has been used to determine the three-dimensional structure of a domain of the rotor protein FliG. This domain functions

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directly in motor rotation, and is known to interact with proteins of the stator. This is the first high-resolution structure determined for any component of the flagellum. In the work proposed here, the FliG domain structure will be exploited to guide detailed biochemical and functional studies of this key rotor component. Another flagellar rotor protein, FliN, has also been crystallized and preliminary data show that it will be feasible to determine its structure. The structure of FliN will be determined, and also used to guide biochemical and functional studies. The long-term goal of this work is to understand the structure of the protein complex that forms the flagellar rotor, and to understand the mechanism of motor rotation in light of this structure. The proposed work will bring us significantly nearer this goal, by revealing structures and spatial relationship of rotor components in unprecedented detail. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE DIARY OF JOSEPH J MERSMAN, 1847-1864 Principal Investigator & Institution: Fisher, Linda A.; Individual Award--Fisher, Linda A. 4026 Woodland Rd Annandale, Va 22003 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 30-JUN-2002 Summary: (provided by applicant): This project is to prepare for publication the test and annotation of a diary which gives new insight into mid-nineteenth century life and provides graphic accounts of two diseases which marked the era: cholera and syphilis. Written by Joseph J. Mersman (1924-1892), a German immigrant and capitalist, the diary begins in Cincinnati from 1847 to early 1849, and continues in St. Louis until September 1864. His is the story of a self-made member of the burgeoning middle class, with a taste for theater and an eye for women. Family members mentioned in the diary include the writer's sister, Agnes Mersman Lake, the circus star who later married James Butler 'Wild Bill' Hickok. Mostly in English the diary contains sections in French and German and describes many developments in business, social and health matters. The booming capitalist economy, the political climate of the country, and the social networks of immigrants are all part of Mersman's record. The diary includes details of cholera epidemics in 1849 and 1853. Mersman's description of premarital sexual encounters and one year of treatment for syphilis is unlike any other published pre-Civil War narrative. Other documents and textbooks written for and by health professionals, record medical treatments of the era. However, there are few reports of cholera and syphilis from the patient's perspective. The project will include transcribing the handwritten document, providing a critical introduction, extensive footnotes and illustrations. This project will fill a now unmet need for a primary document that illustrates important nineteenth century urban American issues. This diary vividly describes the state of public health in two western cities 150 years ago and provides a unique contribution to existing literature. Although many diaries and personal papers of ordinary people from the same period have been published, they generally focus on the Westward Expansion, the 1849 Gold Rush, or Civil War accounts. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: TRUCKER TRANSMISSION

NETWORKS,

DRUG

USE,

AND

DISEASE

Principal Investigator & Institution: Apostolopoulos, Yorghos; Family and Preventive Medicine; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002; Project Start 20-SEP-2002; Project End 30-JUN-2006

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Summary: (provided by applicant): The proposed research is designed to study the sexual and drug networks of US long-haul truckers and their potential role in the acquisition and dissemination of sexually transmitted and blood-borne infections. It builds upon and extends our small-scale studies with truckers, "truck chasers," and other trucker network groups that revealed extensive risk-taking, ranging from IDU to frequently unprotected sex. With primarily male heterosexual truckers at their center, trucker risk networks include such diverse groups as: men who have sex with men including "truck chasers" and sex workers (CB hustlers, "buffaloes"); female sex workers (CB prostitutes, "lot lizards," "traveling ladies," American and Mexican brothel workers, motel sex workers, street walkers/hustlers); female "truck chasers;" drug dealers/pushers/runners and pimps; "polishers," "lumpers," homeless, and hitchhikers; trucking company and truck plaza employees; home setting social and risk contacts; and other sexual and drug contacts on the road. Despite demonstrated links between trucking routes and STI/HIV transmission in other parts of the globe, and truckers' potential role as bridges between populations with significant structural equivalence within truck plazas and other highway trucker settings in the US, there exists a research lacuna in the potential public-health repercussions of the constant movement of 3.3 million US. long-haul truckers. A combination of qualitative and quantitative designs and methodologies as well as biological testing are planned to achieve four specific aims: 1) the comprehensive ascertainment of how truckers' work milieu, interpersonal relationships, social network configurations, and home settings influence their drug use and sexual behaviors, placing them at risk for acquisition of STI/HIV and other bloodborne and sexually transmitted infections; 2) the establishment of baseline seroprevalence of HIV, HCV, HBV, syphilis, gonorrhea, and Chlamydia among trucker risk-network members and groups to generate epidemiologic profiles of infection; 3) the analysis of ethnographic results of the core trucker risk-network members and groups as well as baseline seroprevalence, in terms of the influence of higher-order causal levels; and 4) the utilization of ethnographic findings to develop and pilot test both paper-andpencil and computer-assisted personal interview (CAPI) versions of a survey instrument to assess truckers' risk taking, their highway, social and risk networks, and the acquisition of STI/HIV and other blood-borne and sexually transmitted infections. The successful implementation of these aims will be instrumental in generating longoverdue epidemiologic estimates of US. trucker networks' risk-taking via a cohort prospective study and in initiating an assessment process that will lead to risk/infection/disease mapping across trucking routes as well as risk reduction interventions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: WHOLE GENOME PHAGE DISPLAY OF T PALLIDUM GENES Principal Investigator & Institution: Palzkill, Timothy; Associate Professor; Microbiology and Immunology; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2001; Project Start 15-JUL-1999; Project End 31-AUG-2002 Summary: The function of many genes cannot be deduced from sequence similiarity, and biochemical methods are usually required. Whole genome sequences can be thought of as not only a set of genes but also collections of functional domains. These domains can be studied by affinity methods whereby identification of the ligand can provide information on biochemical function. To take advantage of this method, one must express all functional domains in a form suitable for affinity studies. Phage display technology provides a means for accomplishing this. Phage display libraries that include all of the open reading frames (ORFs) of Treponema pallidum will be constructed. T.

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Syphilis

pallidum is the causative agent of syphilis. The complete genome sequence of this organism has recently been completed. Several features of T. pallidum make it an excellent system on which to develop and test genomic phage display technology. First, with a size of 1 million base pairs, the genome is one of the smallest known. Second, there are a total of 1041 open reading frames which makes it feasible to systematically construct libraries containing each ORF in a relatively short period of time. Finally, little is known of the biology or pathogensis of this organism because a continuous culture system is not available. This severely limits the experimental options for study of the organism. Therefore, new approaches are needed to understand gene function in T. pallidum. Two types of phage display libraries will be constructed. One type will be constructed by systematically inserting each of the 1041 ORFs of T. pallidum into a phage display vector. The second library will be constructed by shotgun cloning of randomly fragmented T. pallidum genomic DNA. The libraries will be used to identify ORFs that are involved in attachment of T. pallidum to fibronectin and host cells. In addition, the libraries will be used to identify T. pallidum DNA binding proteins and locate their binding sites. This information can be used to discover T. pallidum transcriptonal regulatory networks. The work will also serve as a model system for the use of genomic phage display as a tool for functional genomics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: WIDOW INHERITANCE AND HIV INFECTION IN KENYA Principal Investigator & Institution: Agot, Kawango E.; University of Nairobi Box 30197 Nairobi, Timing: Fiscal Year 2002; Project Start 24-SEP-2002; Project End 30-JUN-2007 Summary: (provided by applicant) We propose to conduct a prospective cohort study to investigate the association between widow inheritance and HIV infection among the Luo ethnic community in Kenya--the community with the highest HIV prevalence in the country. The specific aims of the study are to: 1) assess the association between widow inheritance and acquisition of HIV; 2) examine the relationship between HIV infection and being inherited by a brother-in-law versus by a 'professional' inheritor; 3) evaluate the difference in HIV risk associated with being inherited for companionship and support versus for sexual cleansing; and 4) identify correlates of inheritance overall, as well as of the different types of the practice. To achieve these aims, we will recruit 992 widows through radio announcements; women's, widow's and church groups; fliers, posters and brochures; health talks in clinics; chiefs' community meetings; and Focus Group Discussions with widows. At visit 1, those who consent will be counseled and tested for HIV. Those seronegative and are willing to join the study will come for visit 2 when they will be interviewed on their sociodemographic characteristics, sexual behavior, and medical history. They will also provide blood specimens for gonorrhoea, HSV-2, syphilis, and trichomonas virginals tests. Swabs will be taken from those with genital ulcers to test for haemophillus ducreyi. They will then be followed up quarterly for 24 months, during which time the activities performed at enrolment will be repeated. Exposure will be inheritance, including the different types of the practice, while the main outcome will be HIV seroconversion rate and the secondary outcomes will be the incidence of the various types of STIs. We shall use Epi-lnfo software to enter data and to perform crude and adjusted ManteI-Haenszel tests to obtain the relative risk of acquiring HIV and STI given that a widow is inherited relative to those not inherited. Logistic regression analysis will be used to identify which characteristics are independently related to inheritance. The findings will be the first scientific study of this

Studies

31

association and will help in designing HIV intervention programs that are informed by research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: WOMEN'S RISK NETWORKS: RESOURCES, INFECTION AND CHANGE Principal Investigator & Institution: Miller, Maureen; Assistant Professor; Epidemiology; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2001; Project Start 01-MAY-2001; Project End 30-APR-2005 Summary: (provided by applicant): African American women contract HIV, and other sexually transmitted and blood borne pathogens, at an unacceptably high rate, despite 15 years of prevention efforts. The continued spread of HIV among women suggests that individual level HIV preventive interventions may not be sufficient to stem the tide of infection among women. One hundred sixty African American women, aged 16 to 40, who used injected or non-injected cocaine, crack and/or heroin in the past 30 days will be street recruited in Bedford Stuyvesant, New York City, a high AIDS prevalence neighborhood, and followed for 18 months at six month intervals. Index women will nominate and assist in recruiting their current drug use and sex risk network members into the study at each interview. The baseline sample 640 subjects will consist of 160 index women and 480 risk network members. We propose to examine the relationships among socioeconomic factors, egocentric risk networks, individual risk behaviors, and the risk of infection. The five specific aims are: (1) establish the baseline seroprevalence of HIV, Hepatitis C (HCV), Hepatitis B (HBV), and syphilis, and the baseline seroincidence of HIV, among index women and their risk network members; (2) describe index women's resource acquisition strategies and the relationship of these strategies to egocentric risk network variables, individual risk behaviors, and infection; (3) assess the seroincidence among index women, as well as changes in the seroprevalence and/or seroincidence among women's egocentric risk network members, of HIV, HCV, HBV and syphilis over time, and the resource, risk network, and behavioral factors that predict incident infection; (4) ascertain changes in index women's egocentric risk networks over time that increase or decrease the risk of exposure to infection and/or participation in risk behaviors, and the relationship of network changes to women's resource acquisition strategies; and (5) using qualitative methods, explore the events, situations or actions that result in changes in network membership. The findings from this study should provide preliminary evidence as to the feasibility of implementing network preventive interventions among women who use drugs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and 3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age.

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unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “syphilis” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for syphilis in the PubMed Central database: •

Capture-S, a nontreponemal solid-phase erythrocyte adherence assay for serological detection of syphilis. by Stone DL, Moheng MC, Rolih S, Sinor LT.; 1997 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=229542

•

Characterization of outer membranes isolated from Treponema pallidum, the syphilis spirochete. by Radolf JD, Robinson EJ, Bourell KW, Akins DR, Porcella SF, Weigel LM, Jones JD, Norgard MV.; 1995 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=173603

•

Clinical Comparison of the Treponema pallidum CAPTIA Syphilis-G Enzyme Immunoassay with the Fluorescent Treponemal Antibody Absorption Immunoglobulin G Assay for Syphilis Testing. by Halling VW, Jones MF, Bestrom JE, Wold AD, Rosenblatt JE, Smith TF, Cockerill FR III.; 1999 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=85535

•

Comparative Evaluation of Nine Different Enzyme-Linked Immunosorbent Assays for Determination of Antibodies against Treponema pallidum in Patients with Primary Syphilis. by Schmidt BL, Edjlalipour M, Luger A.; 2000 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=88607

•

Comparison of CAPTIA syphilis G enzyme immunoassay with rapid plasma reagin test for detection of syphilis. by Silletti RP.; 1995 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=228278

•

Comparison of the Serodia Treponema pallidum Particle Agglutination, Captia Syphilis-G, and SpiroTek Reagin II Tests with Standard Test Techniques for Diagnosis of Syphilis. by Pope V, Fears MB, Morrill WE, Castro A, Kikkert SE.; 2000 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=86963

•

Correlation of Immunity in Experimental Syphilis with Serum-Mediated Aggregation of Treponema pallidum Rare Outer Membrane Proteins. by Lewinski MA, Miller JN, Lovett MA, Blanco DR.; 1999 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=116554

•

Defibrination of Blood Plasma for Use in Serological Tests for Syphilis. by Castro AR, Kikkert SE, Fears MB, Pope V.; 2002 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=130115

•

Dot-immunogold filtration assay as a screening test for syphilis. by Huang Q, Lan X, Tong T, Wu X, Chen M, Feng X, Liu R, Tang Y, Zhu Z.; 1996 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=229173

5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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•

Effects of cefetamet (Ro 15-8074) on Treponema pallidum and experimental syphilis. by Fitzgerald TJ.; 1992 Mar; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=190562

•

Efficacy of cefmetazole in the treatment of active syphilis in the rabbit model. by Baker-Zander SA, Lukehart SA.; 1989 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=172684

•

Evaluation of a New Competitive Immunoassay (BioElisa Syphilis) for Screening for Treponema pallidum Antibodies at Various Stages of Syphilis. by Ebel A, Bachelart L, Alonso JM.; 1998 Feb; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=104542

•

Evaluation of INNO-LIA Syphilis Assay as a Confirmatory Test for Syphilis. by Hagedorn HJ, Kraminer-Hagedorn A, De Bosschere K, Hulstaert F, Pottel H, Zrein M.; 2002 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=120265

•

Identification of homologs for thioredoxin, peptidyl prolyl cis-trans isomerase, and glycerophosphodiester phosphodiesterase in outer membrane fractions from Treponema pallidum, the syphilis spirochete. by Shevchenko DV, Akins DR, Robinson EJ, Li M, Shevchenko OV, Radolf JD.; 1997 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=175601

•

Identification of Persistent Infection in Experimental Syphilis by PCR. by Wicher K, Abbruscato F, Wicher V, Collins DN, Auger I, Horowitz HW.; 1998 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=108231

•

Laboratory diagnosis and interpretation of tests for syphilis. by Larsen SA, Steiner BM, Rudolph AH.; 1995 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=172846

•

Lesions of primary and secondary syphilis contain activated cytolytic T cells. by van Voorhis WC, Barrett LK, Nasio JM, Plummer FA, Lukehart SA.; 1996 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=173879

•

Molecular characterization and cellular localization of TpLRR, a processed leucinerich repeat protein of Treponema pallidum, the syphilis spirochete. by Shevchenko DV, Akins DR, Robinson E, Li M, Popova TG, Cox DL, Radolf JD.; 1997 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=179096

•

New Tests for Syphilis: Rational Design of a PCR Method for Detection of Treponema pallidum in Clinical Specimens Using Unique Regions of the DNA Polymerase I Gene. by Liu H, Rodes B, Chen CY, Steiner B.; 2001 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=88053

•

Novel Recombinant-Antigen Enzyme Immunoassay for Serological Diagnosis of Syphilis. by Young H, Moyes A, Seagar L, McMillan A.; 1998 Apr; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=104660

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Re-emerging syphilis: a detrended correspondence analysis of the behaviour of HIV positive and negative gay men. by Wheater CP, Cook PA, Clark P, Syed Q, Bellis MA.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=280684

•

Roxithromycin (RU 965): effective therapy for experimental syphilis infection in rabbits. by Lukehart SA, Baker-Zander SA.; 1987 Feb; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=174689

•

Syphilis Fast Latex Agglutination Test, a Rapid Confirmatory Test. by Fears MB, Pope V.; 2001 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=96155

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Syphilis in pregnant women and their children in the United Kingdom: results from national clinician reporting surveys 1994-7. by Hurtig AK, Nicoll A, Carne C, Lissauer T, Connor N, Webster JP, Ratcliffe L.; 1998 Dec 12; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28738

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Syphilis: Have we dropped the ball? by Weir E, Fishman D.; 2002 Nov 26; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=134140

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Syphilis: Review with Emphasis on Clinical, Epidemiologic, and Some Biologic Features. by Singh AE, Romanowski B.; 1999 Apr; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=88914

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Target organs of infection in guinea pigs with acquired congenital syphilis. by Wicher K, Abbruscato F, Wicher V, Baughn R, Noordhoek GT.; 1996 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=174204

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T-Cell Responses to Treponema pallidum subsp. pallidum Antigens during the Course of Experimental Syphilis Infection. by Arroll TW, Centurion-Lara A, Lukehart SA, Van Voorhis WC.; 1999 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=96806

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Treponema pallidum Surface Immunofluorescence Assay for Serologic Diagnosis of Syphilis. by Marangoni A, Sambri V, Storni E, D'Antuono A, Negosanti M, Cevenini R.; 2000 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=95888

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Use of Synthetic Cardiolipin and Lecithin in the Antigen Used by the Venereal Disease Research Laboratory Test for Serodiagnosis of Syphilis. by Castro AR, Morrill WE, Shaw WA, Gale DC, Park MM, Peregrino-Ferreira LA, Bazzo ML, Pope V.; 2000 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=95930

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Use of the Treponema pallidum-specific captia syphilis IgG assay in conjunction with the rapid plasma reagin to test for syphilis. by Reisner BS, Mann LM, Tholcken CA, Waite RT, Woods GL.; 1997 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=232718

•

Validation of the INNO-LIA Syphilis Kit as a Confirmatory Assay for Treponema pallidum Antibodies. by Ebel A, Vanneste L, Cardinaels M, Sablon E, Samson I, De Bosschere K, Hulstaert F, Zrein M.; 2000 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=88698

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Western Immunoblotting with Five Treponema pallidum Recombinant Antigens for Serologic Diagnosis of Syphilis. by Sambri V, Marangoni A, Eyer C, Reichhuber C, Soutschek E, Negosanti M, D'Antuono A, Cevenini R.; 2001 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=96096

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with syphilis, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “syphilis” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for syphilis (hyperlinks lead to article summaries): •

A case of early congenital syphilis. Author(s): Kolivras A, De Maubeuge J, Song M, Hansen V, Toppet V, Van Herreweghe I. Source: Dermatology (Basel, Switzerland). 2002; 204(4): 338-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12077542&dopt=Abstract

•

A case of neurosyphilis with a florid Jarisch-Herxheimer reaction. Author(s): Silberstein P, Lawrence R, Pryor D, Shnier R. Source: Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia. 2002 November; 9(6): 689-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12604286&dopt=Abstract

•

A case study of antenatal syphilis screening in South Africa: successes and challenges. Author(s): Beksinska ME, Mullick S, Kunene B, Rees H, Deperthes B. Source: Sexually Transmitted Diseases. 2002 January; 29(1): 32-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11773876&dopt=Abstract

6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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•

A patient with primary syphilis of the finger. Author(s): Bonci A, Di Lernia V, Lo Scocco G, Bisighini G. Source: Acta Dermato-Venereologica. 2001 October-November; 81(5): 382-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11800158&dopt=Abstract

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A pilot study evaluating ceftriaxone and penicillin G as treatment agents for neurosyphilis in human immunodeficiency virus-infected individuals. Author(s): Marra CM, Boutin P, McArthur JC, Hurwitz S, Simpson PA, Haslett JA, van der Horst C, Nevin T, Hook EW 3rd. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2000 March; 30(3): 540-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10722441&dopt=Abstract

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A randomized, comparative pilot study of azithromycin versus benzathine penicillin G for treatment of early syphilis. Author(s): Hook EW 3rd, Martin DH, Stephens J, Smith BS, Smith K. Source: Sexually Transmitted Diseases. 2002 August; 29(8): 486-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12172535&dopt=Abstract

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A reply to comments on sociocultural issues in clinical research: unraveling the Tuskegee syphilis study. Author(s): Alarcon GS. Source: Arthritis and Rheumatism. 2002 December 15; 47(6): 691. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12522847&dopt=Abstract

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A serosurvey of hepatitis B virus, hepatitis C virus, human T lymphotropic virus type-1 and syphilis in HIV-1-infected patients in Jamaica. Author(s): Smikle MF, Heslop O, Vickers I, Dowe G, Deer D, Sue-Ho R, Denbow CE, St C Morgan O, Bain B, Barton EN. Source: The West Indian Medical Journal. 2003 March; 52(1): 14-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12806748&dopt=Abstract

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Absence of risk factors for false-positive test results in blood donors with a reactive test result in an automated treponemal test (PK-TP) for syphilis. Author(s): Orton SL, Dodd RY, Williams AE; ARCNET Epidemiology Group. American Red Cross. Source: Transfusion. 2001 June; 41(6): 744-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11399813&dopt=Abstract

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Accelerated atherosclerosis in tertiary syphilis and successful treatment with saphenous vein grafting--a case report. Author(s): Ogus NT, Cakalagaoglu C, Cakalagaoglu F, Cicek S. Source: Angiology. 2001 August; 52(8): 549-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11512694&dopt=Abstract

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Acceptance of syphilis screening among residents of high-STD-risk Houston communities. Author(s): Baseman J, Leonard L, Ross M, Hwang LY. Source: International Journal of Std & Aids. 2001 November; 12(11): 744-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11589815&dopt=Abstract

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Activated and mature CD83-positive dendritic cells and interferon-gamma-positive cells in skin eruptions of secondary syphilis. Author(s): Koga T, Duan H, Moroi Y, Urabe K, Furue M. Source: Acta Dermato-Venereologica. 2003; 83(3): 214-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12816159&dopt=Abstract

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Active ocular syphilis. Author(s): Peters GB 3rd, Krohel GB. Source: Ophthalmology. 2001 September; 108(9): 1515-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11535434&dopt=Abstract

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AIDS mortality may have contributed to the decline in syphilis rates in the United States in the 1990s. Author(s): Chesson HW, Dee TS, Aral SO. Source: Sexually Transmitted Diseases. 2003 May; 30(5): 419-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12916133&dopt=Abstract

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Amplification of the DNA polymerase I gene of Treponema pallidum from whole blood of persons with syphilis. Author(s): Marfin AA, Liu H, Sutton MY, Steiner B, Pillay A, Markowitz LE. Source: Diagnostic Microbiology and Infectious Disease. 2001 August; 40(4): 163-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11576788&dopt=Abstract

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An intervention study to reduce adverse pregnancy outcomes as a result of syphilis in Mozambique. Author(s): Bique Osman N, Challis K, Folgosa E, Cotiro M, Bergstrom S. Source: Sexually Transmitted Infections. 2000 June; 76(3): 203-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10961199&dopt=Abstract

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An outbreak no longer: factors contributing to the return of syphilis in Greater Manchester. Author(s): Ashton M, Sopwith W, Clark P, McKelvey D, Lighton L, Mandal D. Source: Sexually Transmitted Infections. 2003 August; 79(4): 291-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12902577&dopt=Abstract

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An outbreak of early syphilis: cases from North Manchester General Hospital. Author(s): Lacey HB, Higgins SP, Graham D. Source: Sexually Transmitted Infections. 2001 October; 77(5): 311-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11588269&dopt=Abstract

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An outbreak of syphilis in Alabama prisons: correctional health policy and communicable disease control. Author(s): Wolfe MI, Xu F, Patel P, O'Cain M, Schillinger JA, St Louis ME, Finelli L. Source: American Journal of Public Health. 2001 August; 91(8): 1220-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11499107&dopt=Abstract

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An outbreak of syphilis in Oslo. Author(s): Halsos AM, Edgardh K. Source: International Journal of Std & Aids. 2002 June; 13(6): 370-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12015009&dopt=Abstract

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An unusual presentation of secondary syphilis in otolaryngology. Author(s): Yuen HW, Luke KS, Yeoh KH. Source: Otolaryngology and Head and Neck Surgery. 2001 September; 125(3): 277-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11555768&dopt=Abstract

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Angle-closure glaucoma as a presumed presenting sign in patients with syphilis. Author(s): Matsuo T, Taira Y, Nagayama M, Baba T. Source: Japanese Journal of Ophthalmology. 2000 May-June; 44(3): 305-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10913652&dopt=Abstract

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Antibacterial therapy of neurosyphilis: lack of impact of new therapies. Author(s): Ali L, Roos KL. Source: Cns Drugs. 2002; 16(12): 799-802. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12421113&dopt=Abstract

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Anti-beta2 glycoprotein I and anticardiolipin antibodies in leptospirosis, syphilis and Kala-azar. Author(s): Santiago M, Martinelli R, Ko A, Reis EA, Fontes RD, Nascimento EG, Pierangeli S, Espinola R, Gharavi A. Source: Clin Exp Rheumatol. 2001 July-August; 19(4): 425-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11491498&dopt=Abstract

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Antibiotics for syphilis diagnosed during pregnancy. Author(s): Walker GJ. Source: Cochrane Database Syst Rev. 2001; (3): Cd001143. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11686978&dopt=Abstract

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Are trends in HIV, gonorrhoea, and syphilis worsening in western Europe? Author(s): Nicoll A, Hamers FF. Source: Bmj (Clinical Research Ed.). 2002 June 1; 324(7349): 1324-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12039830&dopt=Abstract

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Argyll-Robertson pupil and neurosyphilis. Author(s): Berkowitz HL. Source: Psychosomatics. 2002 July-August; 43(4): 340-1; Author Reply 341. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12189266&dopt=Abstract

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Asymptomatic bilateral optic perineuritis in secondary syphilis. Author(s): Gartaganis S, Georgiou S, Monastirli A, Katsimpris J, Pasmatzi E, Tsambaos D. Source: Acta Dermato-Venereologica. 2000 January-February; 80(1): 75-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10721854&dopt=Abstract

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Attacking the syphilis epidemic in Baltimore. Author(s): Makulowich GS. Source: Aids Patient Care and Stds. 1998 April; 12(4): 321-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11361966&dopt=Abstract

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Atypical manifestation of primary syphilis. Author(s): Bader U. Source: The American Journal of Medicine. 2000 April 15; 108(6): 521-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10866591&dopt=Abstract

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Bayes' theorem-based assessment of VDRL syphilis screening miss rates. Author(s): Muic V, Ljubicic M, Vodopija I. Source: Sexually Transmitted Diseases. 1999 January; 26(1): 12-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9918318&dopt=Abstract

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Bilateral anterior uveitis as a presenting manifestation of sarcoidosis and syphilis. Author(s): Diaz-Valle D, Toledano N, Miguelez R, Benitez del Castillo JM, Barros C. Source: The British Journal of Ophthalmology. 2002 August; 86(8): 930-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12140218&dopt=Abstract

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Bilateral secondary syphilis of the tonsil. Author(s): Mannara GM, Sacilotto C, Frattasio A, Pedace E, Di Loreto C, Ferlito A. Source: The Journal of Laryngology and Otology. 1999 December; 113(12): 1125-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10767935&dopt=Abstract

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Bilateral tonic pupils associated with neurosyphilis. Author(s): Sakai T, Shikishima K, Mizobuchi T, Yoshida M, Kitahara K. Source: Japanese Journal of Ophthalmology. 2003 July-August; 47(4): 368-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842205&dopt=Abstract

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Can genes solve the syphilis mystery? Author(s): Zimmer C. Source: Science. 2001 May 11; 292(5519): 1091. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11352060&dopt=Abstract

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Can syphilis be eradicated from the world? Author(s): Rompalo AM. Source: Current Opinion in Infectious Diseases. 2001 February; 14(1): 41-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11979114&dopt=Abstract

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CDC says rates are up for gonorrhea, down for syphilis. Author(s): Vastag B. Source: Jama : the Journal of the American Medical Association. 2001 January 10; 285(2): 155. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11176791&dopt=Abstract

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Central nervous system infection in congenital syphilis. Author(s): Michelow IC, Wendel GD Jr, Norgard MV, Zeray F, Leos NK, Alsaadi R, Sanchez PJ. Source: The New England Journal of Medicine. 2002 June 6; 346(23): 1792-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12050339&dopt=Abstract

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Characteristics of individuals with male-to-male and heterosexually acquired infectious syphilis during an outbreak in Calgary, Alberta, Canada. Author(s): Jayaraman GC, Read RR, Singh A. Source: Sexually Transmitted Diseases. 2003 April; 30(4): 315-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12671551&dopt=Abstract

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Characteristics of persons with syphilis in areas of persisting syphilis in the United States: sustained transmission associated with concurrent partnerships. Author(s): Koumans EH, Farley TA, Gibson JJ, Langley C, Ross MW, McFarlane M, Braxton J, St Louis ME. Source: Sexually Transmitted Diseases. 2001 September; 28(9): 497-503. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11518865&dopt=Abstract

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Clinical and epidemiological features of syphilis in pregnant women: the course and outcome of pregnancy. Author(s): Mavrov GI, Goubenko TV. Source: Gynecologic and Obstetric Investigation. 2001; 52(2): 114-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11586039&dopt=Abstract

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Clinical manifestations of early syphilis by HIV status and gender: results of the syphilis and HIV study. Author(s): Rompalo AM, Joesoef MR, O'Donnell JA, Augenbraun M, Brady W, Radolf JD, Johnson R, Rolfs RT; Syphilis and HIV Study Group. Source: Sexually Transmitted Diseases. 2001 March; 28(3): 158-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11289198&dopt=Abstract

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Clozapine in the treatment of hypomania with neurosyphilis. Author(s): Mahendran R. Source: The Journal of Clinical Psychiatry. 2001 June; 62(6): 477-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11465530&dopt=Abstract

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Collaboration is key to preventing syphilis. Author(s): Fenton KA, Doherty L. Source: Bmj (Clinical Research Ed.). 2002 November 9; 325(7372): 1116. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12424182&dopt=Abstract

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Colleague says Clinton nominee learned of syphilis study in 1969. Author(s): Lewis NA. Source: Ny Times (Print). 1995 February 28; : A19. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11647060&dopt=Abstract

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Commentary: bread and alum, syphilis and sunlight: rickets in the nineteenth century. Author(s): Hardy A. Source: International Journal of Epidemiology. 2003 June; 32(3): 337-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12777414&dopt=Abstract

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Common symptoms--different diseases: coexistence of neurosyphilis and nonHodgkin's lymphoma. Author(s): Mantadakis E, Samonis G. Source: Infection. 2002 January; 30(1): 43-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11876517&dopt=Abstract

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Comparative evaluation of nine different enzyme-linked immunosorbent assays for determination of antibodies against Treponema pallidum in patients with primary syphilis. Author(s): Schmidt BL, Edjlalipour M, Luger A. Source: Journal of Clinical Microbiology. 2000 March; 38(3): 1279-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10699042&dopt=Abstract

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Comparison of a recombinant-antigen enzyme immunoassay with Treponema pallidum hemagglutination test for serological confirmation of syphilis. Author(s): Rodriguez I, Alvarez EL, Fernandez C, Miranda A. Source: Memorias Do Instituto Oswaldo Cruz. 2002 April; 97(3): 347-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12048563&dopt=Abstract

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Comparison of seropositivity of HIV, HBV, HCV and syphilis in replacement and voluntary blood donors in western India. Author(s): Garg S, Mathur DR, Garg DK. Source: Indian J Pathol Microbiol. 2001 October; 44(4): 409-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12035351&dopt=Abstract

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Comparison of the Serodia Treponema pallidum particle agglutination, Captia Syphilis-G, and SpiroTek Reagin II tests with standard test techniques for diagnosis of syphilis. Author(s): Pope V, Fears MB, Morrill WE, Castro A, Kikkert SE. Source: Journal of Clinical Microbiology. 2000 July; 38(7): 2543-5. Erratum In: J Clin Microbiol 2001 October; 39(10): 3817. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10878040&dopt=Abstract

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Concurrent partnerships and syphilis persistence: new thoughts on an old puzzle. Author(s): Morris M. Source: Sexually Transmitted Diseases. 2001 September; 28(9): 504-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11518866&dopt=Abstract

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Confronting the clinical uncertainty regarding syphilis. Author(s): Hicks CB, Beckwith CG, Mitty J, Flanigan TP. Source: Aids Clin Care. 2003 July; 15(7): 64-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12913954&dopt=Abstract

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Congenital syphilis after maternal treatment for syphilis during pregnancy. Author(s): Sheffield JS, Sanchez PJ, Morris G, Maberry M, Zeray F, McIntire DD, Wendel GD Jr. Source: American Journal of Obstetrics and Gynecology. 2002 March; 186(3): 569-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11904625&dopt=Abstract

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Congenital syphilis and fluorescent treponemal antibody test reactivity after the age of 1 year. Author(s): Rawstron SA, Mehta S, Marcellino L, Rempel J, Chery F, Bromberg K. Source: Sexually Transmitted Diseases. 2001 July; 28(7): 412-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11460026&dopt=Abstract

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Congenital syphilis at Goroka Base Hospital: incidence, clinical features and risk factors for mortality. Author(s): Frank D, Duke T. Source: P N G Med J. 2000 March-June; 43(1-2): 121-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11407606&dopt=Abstract

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Congenital syphilis following negative antenatal screening. Author(s): Richardson MP, Palfreeman A, Nielsen PB, Fenton KA. Source: Commun Dis Public Health. 2002 March; 5(1): 72-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12070982&dopt=Abstract

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Congenital syphilis in the 21st century. Author(s): Carey JC. Source: Curr Womens Health Rep. 2003 August; 3(4): 299-302. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12844452&dopt=Abstract

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Congenital syphilis in the Russian Federation: magnitude, determinants, and consequences. Author(s): Tikhonova L, Salakhov E, Southwick K, Shakarishvili A, Ryan C, Hillis S; Congenital Syphilis Investigation Team. Source: Sexually Transmitted Infections. 2003 April; 79(2): 106-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12690129&dopt=Abstract

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Congenital syphilis surveillance and newborn evaluation in a low-incidence state. Author(s): Martin D, Bertrand J, McKegney C, Thompson L, Belongia E, Mills W. Source: Archives of Pediatrics & Adolescent Medicine. 2001 February; 155(2): 140-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11177087&dopt=Abstract

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Congenital syphilis. Author(s): Sudheer MS, Silveira MP. Source: Indian Pediatrics. 2002 October; 39(10): 972-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12428046&dopt=Abstract

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Congenital syphilis--missed opportunities for prenatal intervention. Author(s): Chudomirova K, Mihajlova E, Ivanov I, Lasarov S, Stefanova P. Source: Sexually Transmitted Infections. 2002 June; 78(3): 224-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12238662&dopt=Abstract

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Cortical reflex action myoclonus in neurosyphilis. Author(s): Okuma Y, Tanaka R, Fujishima K, Kobayashi T, Mizuno Y. Source: European Neurology. 2001; 45(3): 193-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11306871&dopt=Abstract

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Cutaneous lesions of secondary syphilis are highly angiogenic. Author(s): Macaron NC, Cohen C, Chen SC, Arbiser JL. Source: Journal of the American Academy of Dermatology. 2003 June; 48(6): 878-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12789178&dopt=Abstract

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De novo status epilepticus as the presenting sign of neurosyphilis. Author(s): Primavera A, Solaro C, Cocito L. Source: Epilepsia. 1998 December; 39(12): 1367-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9860076&dopt=Abstract

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Decline in prevalence of HIV-1 infection and syphilis among young women attending antenatal care clinics in Addis Ababa, Ethiopia: results from sentinel surveillance, 1995-2001. Author(s): Tsegaye A, Rinke De Wit TF, Mekonnen Y, Beyene A, Aklilu M, Messele T, Abebe A, Coutinho R, Sanders E, Fontanet AL. Source: Journal of Acquired Immune Deficiency Syndromes (1999). 2002 July 1; 30(3): 359-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12131574&dopt=Abstract

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Declining syphilis prevalence in pregnant women in Nairobi since 1995: another success story in the STD field? Author(s): Temmerman M, Fonck K, Bashir F, Inion I, Ndinya-Achola JO, Bwayo J, Kirui P, Claeys P, Fransen L. Source: International Journal of Std & Aids. 1999 June; 10(6): 405-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10414884&dopt=Abstract

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Decreased congenital syphilis incidence in Haiti's rural Artibonite region following decentralized prenatal screening. Author(s): Fitzgerald DW, Behets F, Preval J, Schulwolf L, Bommi V, Chaillet P. Source: American Journal of Public Health. 2003 March; 93(3): 444-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12604493&dopt=Abstract

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Defibrination of blood plasma for use in serological tests for syphilis. Author(s): Castro AR, Kikkert SE, Fears MB, Pope V. Source: Clinical and Diagnostic Laboratory Immunology. 2002 November; 9(6): 1376-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12414778&dopt=Abstract

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Dementia following an acute presentation of meningovascular neurosyphilis in an HIV-1 positive patient. Author(s): Fox PA, Hawkins DA, Dawson S. Source: Aids (London, England). 2000 September 8; 14(13): 2062-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10997420&dopt=Abstract

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Dementia paralytica (neurosyphilis): a clinical case study. Author(s): Ilankovic N, Ivkovic M, Sokic D, Ilankovic A, Milovanovic S, Filipovic B, Tiosavljevic D, Ilankovic V, Bojic V. Source: World J Biol Psychiatry. 2003 July; 4(3): 135-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872208&dopt=Abstract

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Diagnosis and management of syphilis. Author(s): Brown DL, Frank JE. Source: American Family Physician. 2003 July 15; 68(2): 283-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12892348&dopt=Abstract

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Diagnostic relevance of polymerase chain reaction technology for T. pallidum in subjects with syphilis in different phases of infection. Author(s): Pietravalle M, Pimpinelli F, Maini A, Capoluongo E, Felici C, D'Auria L, Di Carlo A, Ameglio F. Source: New Microbiol. 1999 April; 22(2): 99-104. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10322608&dopt=Abstract

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Did Justinian the Great (527-565 CE) suffer from syphilis? Author(s): Lascaratos J, Poulakou-Rebelakou E. Source: International Journal of Dermatology. 1999 October; 38(10): 787-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10561056&dopt=Abstract

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Different types of antiphospholipid antibodies in AIDS: a comparison with syphilis and the antiphospholipid syndrome. Author(s): de Larranaga GF, Forastiero RR, Carreras LO, Alonso BS. Source: Thrombosis Research. 1999 October 1; 96(1): 19-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10554081&dopt=Abstract

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Do clinicians screen Medicaid patients for syphilis or HIV when they diagnose other sexually transmitted diseases? Author(s): Rust G, Minor P, Jordan N, Mayberry R, Satcher D. Source: Sexually Transmitted Diseases. 2003 September; 30(9): 723-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972797&dopt=Abstract

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Don't forget syphilis. Access to services for genitourinary medicine needs to be made easier. Author(s): Goldmeier D, Greene L. Source: Bmj (Clinical Research Ed.). 2002 October 5; 325(7367): 775. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12370965&dopt=Abstract

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Don't forget syphilis. Syphilis outbreak is twice as big as reported. Author(s): Clark P, Cook PA, Lighton L, Syed Q, Bellis MA. Source: Bmj (Clinical Research Ed.). 2002 October 5; 325(7367): 775. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12364312&dopt=Abstract

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Drug treatment of common STDs: part I. Herpes, syphilis, urethritis, chlamydia and gonorrhea. Author(s): Woodward C, Fisher MA. Source: American Family Physician. 1999 October 1; 60(5): 1387-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10524484&dopt=Abstract

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Drug use and syphilis. Co-factors for HIV transmission among commercial sex workers in Guyana. Author(s): Persaud NE, Klaskala W, Tewari T, Shultz J, Baum M. Source: The West Indian Medical Journal. 1999 June; 48(2): 52-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10492602&dopt=Abstract

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Early congenital syphilis in the new millennium. Author(s): Karthikeyan K, Thappa DM. Source: Pediatric Dermatology. 2002 May-June; 19(3): 275-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12047653&dopt=Abstract

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Early congenital syphilis. Author(s): Peihong J, Zhiyong L, Rengui C, Jian W. Source: International Journal of Dermatology. 2001 March; 40(3): 198-202. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11422526&dopt=Abstract

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Effect of a syphilis control programme on pregnancy outcome in Nairobi, Kenya. Author(s): Temmerman M, Gichangi P, Fonck K, Apers L, Claeys P, Van Renterghem L, Kiragu D, Karanja G, Ndinya-Achola J, Bwayo J. Source: Sexually Transmitted Infections. 2000 April; 76(2): 117-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10858713&dopt=Abstract

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Effectiveness and cost-benefit of enhancements to a syphilis screening and treatment program at a county jail. Author(s): Silberstein GS, Coles FB, Greenberg A, Singer L, Voigt R. Source: Sexually Transmitted Diseases. 2000 October; 27(9): 508-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11034525&dopt=Abstract

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Efficacy of penicillin G benzathine as antimicrobial treatment of cutaneous secondary syphilis in patients with HIV infection. Author(s): Calza L, Manfredi R, Marinacci G, Tadolini M, Fortunato L, Chiodo F. Source: Journal of Chemotherapy (Florence, Italy). 2002 October; 14(5): 533-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12462435&dopt=Abstract

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Enzywell recombinant enzyme immunoassay for the serological diagnosis of syphilis. Author(s): Young H, Aktas G, Moyes A. Source: International Journal of Std & Aids. 2000 May; 11(5): 288-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10824936&dopt=Abstract

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Epidemics due to imported syphilis in Finland. Author(s): Hiltunen-Back E, Haikala O, Koskela P, Vaalasti A, Reunala T. Source: Sexually Transmitted Diseases. 2002 December; 29(12): 746-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12466714&dopt=Abstract

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Epidemiology of syphilis and gonorrhoea in eastern Poland in the years 1988-1997. Author(s): Chodynicka B, Serwin AB, Janczylo-Jankowska M, Waugh MA. Source: International Journal of Std & Aids. 1999 October; 10(10): 680-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10582638&dopt=Abstract

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Epidemiology of syphilis in Bulgaria, 1990-1998. Author(s): Dencheva R, Spirov G, Gilina K, Niagolova D, Pehlivanov G, Tsankov N, Waugh MA. Source: International Journal of Std & Aids. 2000 December; 11(12): 819-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11138918&dopt=Abstract

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Epidemiology of syphilis in Hungary between 1952 and 1996. Author(s): Varkonyi V, Tisza T, Horvath A, Takacsy T, Berecz M, Kulcsar G, Sardy M. Source: International Journal of Std & Aids. 2000 May; 11(5): 327-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10824942&dopt=Abstract

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Epidemiology of syphilis. Author(s): Makulowich GS. Source: Aids Patient Care and Stds. 1998 March; 12(3): 233-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11361946&dopt=Abstract

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Erasmus, syphilis, and the abuse of stigma. Author(s): Whitty CJ. Source: Lancet. 1999 December 18-25; 354(9196): 2147-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10609831&dopt=Abstract

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Ethics and experimentation on human subjects in mid-nineteenth-century France: the story of the 1859 syphilis experiments. Author(s): Dracobly A. Source: Bulletin of the History of Medicine. 2003 Summer; 77(2): 332-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12955963&dopt=Abstract

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European guideline for the management of syphilis. Author(s): Goh BT, van Voorst Vader PC; European Branch of the International Union against Sexually Transmitted Infection and the European Office of the World Health Organization. Source: International Journal of Std & Aids. 2001 October; 12 Suppl 3: 14-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11589792&dopt=Abstract

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Evaluation of INNO-LIA syphilis assay as a confirmatory test for syphilis. Author(s): Hagedorn HJ, Kraminer-Hagedorn A, De Bosschere K, Hulstaert F, Pottel H, Zrein M. Source: Journal of Clinical Microbiology. 2002 March; 40(3): 973-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11880425&dopt=Abstract

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Evaluation of rapid diagnostic tests for the detection of human immunodeficiency virus types 1 and 2, hepatitis B surface antigen, and syphilis in Ho Chi Minh City, Vietnam. Author(s): Lien TX, Tien NT, Chanpong GF, Cuc CT, Yen VT, Soderquist R, Laras K, Corwin A. Source: The American Journal of Tropical Medicine and Hygiene. 2000 February; 62(2): 301-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10813489&dopt=Abstract

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Evaluation of recomWell Treponema, a novel recombinant antigen-based enzymelinked immunosorbent assay for the diagnosis of syphilis. Author(s): Sambri V, Marangoni A, Simone MA, D'Antuono A, Negosanti M, Cevenini R. Source: Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases. 2001 April; 7(4): 200-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11422242&dopt=Abstract

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Evaluation of syphilis reactor grids: optimizing impact. Author(s): Schaffzin JK, Koumans EH, Kahn RH, Markowitz LE. Source: Sexually Transmitted Diseases. 2003 September; 30(9): 700-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972793&dopt=Abstract

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Evaluation of the Bio-Rad syphilis IgG test performed on the CODA system for serologic diagnosis of syphilis. Author(s): Tholcken CA, Woods GL. Source: Diagnostic Microbiology and Infectious Disease. 2000 July; 37(3): 157-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10904187&dopt=Abstract

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Evaluation of the passive particle agglutination test in the serodiagnosis and followup of syphilis. Author(s): Castro RR, Prieto ES, Santo I, Azevedo J, Exposto FL. Source: American Journal of Clinical Pathology. 2001 October; 116(4): 581-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11605611&dopt=Abstract

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Examining the direct costs and effectiveness of syphilis detection by selective screening and partner notification. Author(s): Reynolds SL, Kapadia AS, Leonard L, Ross MW. Source: Journal of Public Health Medicine. 2001 December; 23(4): 339-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11873899&dopt=Abstract

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Failure of benzathine penicillin in a case of seronegative secondary syphilis in a patient with acquired immunodeficiency syndrome: case report and review of the literature. Author(s): Fowler VG Jr, Maxwell GL, Myers SA, Shea CR, Livengood CN 3rd, Prieto VG, Hicks CB. Source: Archives of Dermatology. 2001 October; 137(10): 1374-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11594871&dopt=Abstract

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False-positive tests for syphilis associated with human immunodeficiency virus and hepatitis B virus infection among intravenous drug abusers. Valencian Study Group on HIV Epidemiology. Author(s): Hernandez-Aguado I, Bolumar F, Moreno R, Pardo FJ, Torres N, Belda J, Espacio A. Source: European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 1998 November; 17(11): 784-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9923520&dopt=Abstract

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Female-to-female transmission of syphilis: a case report. Author(s): Campos-Outcalt D, Hurwitz S. Source: Sexually Transmitted Diseases. 2002 February; 29(2): 119-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11818899&dopt=Abstract

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Fetal syphilis: clinical and laboratory characteristics. Author(s): Hollier LM, Harstad TW, Sanchez PJ, Twickler DM, Wendel GD Jr. Source: Obstetrics and Gynecology. 2001 June; 97(6): 947-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11384701&dopt=Abstract

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First European exposure to syphilis: the Dominican Republic at the time of Columbian contact. Author(s): Rothschild BM, Calderon FL, Coppa A, Rothschild C. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2000 October; 31(4): 936-41. Epub 2000 October 20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11049773&dopt=Abstract

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Forgotten but not gone: the continuing scourge of congenital syphilis. Author(s): Walker DG, Walker GJ. Source: The Lancet Infectious Diseases. 2002 July; 2(7): 432-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12127355&dopt=Abstract

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From the CDC: Syphilis elimination: history in the making--closing remarks. Author(s): Satcher D. Source: Sexually Transmitted Diseases. 2000 February; 27(2): 66-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10676971&dopt=Abstract

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From the CDC: Syphilis elimination: history in the making--opening remarks. Author(s): Koplan J. Source: Sexually Transmitted Diseases. 2000 February; 27(2): 63-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10676970&dopt=Abstract

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Gender differences in testing for syphilis in emergency department patients diagnosed with sexually transmitted diseases. Author(s): Garfinkel M, Blumstein H. Source: The Journal of Emergency Medicine. 1999 November-December; 17(6): 937-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10595874&dopt=Abstract

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Geographic variation of HIV infection in childbearing women with syphilis in the United States. Author(s): Koumans EH, Sternberg M, Gwinn M, Swint E, Zaidi A, St Louis ME. Source: Aids (London, England). 2000 February 18; 14(3): 279-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10716504&dopt=Abstract

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Geriatrics photo quiz. Dermatologic signs of syphilis. Author(s): Shua-Haim JR, Kothari N, Ross JS. Source: Geriatrics. 1999 January; 54(1): 22, 57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9934353&dopt=Abstract

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Gonorrhoea, chlamydia and syphilis incidence in the Kimberley. Author(s): Mak DB, Marshall LJ. Source: Commun Dis Intell. 2003; 27(3): 370-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14510064&dopt=Abstract

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Guidelines for serological testing for syphilis. Author(s): McElborough DJ. Source: Sexually Transmitted Infections. 2001 February; 77(1): 79. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11158707&dopt=Abstract

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Guidelines for serological testing for syphilis. Author(s): Young H. Source: Sexually Transmitted Infections. 2000 October; 76(5): 403-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11141863&dopt=Abstract

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Haemophagocytosis in early congenital syphilis. Author(s): Pohl M, Niemeyer CM, Hentschel R, Duffner U, Bergstrasser E, Brandis M. Source: European Journal of Pediatrics. 1999 July; 158(7): 553-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10412813&dopt=Abstract

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Hepatitis B, syphilis, and human immunodeficiency virus: are different approaches to prenatal screening justified? Author(s): Grimes RM, Richards EP, Rathbun KC. Source: Pediatr Aids Hiv Infect. 1997 April; 8(2): 98-101. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11361783&dopt=Abstract

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Hepatitis, syphilis, and HIV sentinel surveillance in Mongolia 1999-2000. Author(s): Tellez I, Altankhuu M, Vermund S, Gnann JW, Hook EH, Schwebke J. Source: Sexually Transmitted Infections. 2002 June; 78(3): 223-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12238661&dopt=Abstract

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Heterosexual outbreak of infectious syphilis: epidemiological and ethnographic analysis and implications for control. Author(s): Patrick DM, Rekart ML, Jolly A, Mak S, Tyndall M, Maginley J, Wong E, Wong T, Jones H, Montgomery C, Brunham RC. Source: Sexually Transmitted Infections. 2002 April; 78 Suppl 1: I164-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12083438&dopt=Abstract

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High frequency of antibodies to syphilis and HIV in hepatitis C virus positive blood donors may reflect its sexual transmission in this region. Author(s): Mittal A. Source: Sexually Transmitted Infections. 2003 April; 79(2): 170-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12690148&dopt=Abstract

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High prevalence of syphilis and other sexually transmitted diseases among sex workers in China: potential for fast spread of HIV. Author(s): van den Hoek A, Yuliang F, Dukers NH, Zhiheng C, Jiangting F, Lina Z, Xiuxing Z. Source: Aids (London, England). 2001 April 13; 15(6): 753-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11371690&dopt=Abstract

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HIV a sexually transmitted disease? An analysis of the latest antenatal screening for HIV and syphilis from South Africa. Author(s): Mhlongo S, Fiala C, De Harven E, Rasnick D, Stewart GT. Source: International Journal of Std & Aids. 2003 August; 14(8): 574-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12935393&dopt=Abstract

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HIV and syphilis coinfection: trends and interactions. Author(s): Kassutto S, Sax PE. Source: Aids Clin Care. 2003 February; 15(2): 9-15. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12635595&dopt=Abstract

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HIV and syphilis in pregnant women at a tertiary care hospital. Author(s): Vajpayee M, Seth P, Malhotra N. Source: Trop Doct. 2001 January; 31(1): 56. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11205612&dopt=Abstract

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HIV and syphilis serostatus of antenatals in traditional Maasai pasturalist communities in Kajiado District, Kenya: 1989-1992. Author(s): Valadez JJ, Loolpapit PM, Nyangao A, Dikir F. Source: Trop Doct. 1999 April; 29(2): 94-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10418300&dopt=Abstract

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HIV infections and associated costs attributable to syphilis coinfection among African Americans. Author(s): Chesson HW, Pinkerton SD, Voigt R, Counts GW. Source: American Journal of Public Health. 2003 June; 93(6): 943-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12773360&dopt=Abstract

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HIV prevalence in patients with syphilis, United States. Author(s): Blocker ME, Levine WC, St Louis ME. Source: Sexually Transmitted Diseases. 2000 January; 27(1): 53-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10654870&dopt=Abstract

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HIV seropositivity in women with syphilis in Delhi, India. Author(s): Vajpayee M, Malhotra N, Seth P, Takkar D, Pandey RM. Source: Sexually Transmitted Infections. 2000 February; 76(1): 59-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10817078&dopt=Abstract

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HIV, syphilis and heterosexual bridging among Peruvian men who have sex with men. Author(s): Tabet S, Sanchez J, Lama J, Goicochea P, Campos P, Rouillon M, Cairo JL, Ueda L, Watts D, Celum C, Holmes KK. Source: Aids (London, England). 2002 June 14; 16(9): 1271-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12045493&dopt=Abstract

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Human immunodeficiency virus and syphilis seropositivity among patients attending clinic for sexually transmitted disease. Author(s): Vajpayee M, Malhotra N, Pandey RM, Pandhi RK, Seth P. Source: International Journal of Std & Aids. 2000 July; 11(7): 482. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10919493&dopt=Abstract

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IgG western blot as a confirmatory test in early syphilis. Author(s): Marangoni A, Sambri V, Olmo A, D'Antuono A, Negosanti M, Cevenini R. Source: Zentralbl Bakteriol. 1999 April; 289(2): 125-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10360313&dopt=Abstract

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Images in clinical medicine. Oral manifestations of secondary syphilis. Author(s): Ulmer A, Fierlbeck G. Source: The New England Journal of Medicine. 2002 November 21; 347(21): 1677. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12444182&dopt=Abstract

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Impact of mass treatment on syphilis transmission: a mathematical modeling approach. Author(s): Pourbohloul B, Rekart ML, Brunham RC. Source: Sexually Transmitted Diseases. 2003 April; 30(4): 297-305. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12671548&dopt=Abstract

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Impact of on-site testing for maternal syphilis on treatment delays, treatment rates, and perinatal mortality in rural South Africa: a randomised controlled trial. Author(s): Myer L, Wilkinson D, Lombard C, Zuma K, Rotchford K, Karim SS. Source: Sexually Transmitted Infections. 2003 June; 79(3): 208-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12794203&dopt=Abstract

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Impact on perinatal mortality of missed opportunities to treat maternal syphilis in rural South Africa: baseline results from a clinic randomized controlled trial. Author(s): Rotchford K, Lombard C, Zuma K, Wilkinson D. Source: Tropical Medicine & International Health : Tm & Ih. 2000 November; 5(11): 8004. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11123828&dopt=Abstract

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Implementing a syphilis elimination and importation control strategy in a lowincidence urban area: San Diego County, California, 1997-1998. Author(s): Gunn RA, Harper SL, Borntrager DE, Gonzales PE, St Louis ME. Source: American Journal of Public Health. 2000 October; 90(10): 1540-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11029985&dopt=Abstract

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Incident syphilis among women with multiple admissions to jail in New York City. Author(s): Blank S, Sternberg M, Neylans LL, Rubin SR, Weisfuse IB, St Louis ME. Source: The Journal of Infectious Diseases. 1999 October; 180(4): 1159-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10479143&dopt=Abstract

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Increased number of the cases of syphilis in Trabzon, a trade city in the Black Sea region of Turkey. Author(s): Apaydin R, Bilen NG, Gul U, Bahadir S. Source: Sexually Transmitted Infections. 1998 October; 74(5): 377. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10195038&dopt=Abstract

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Infectious syphilis and importance of travel history. Author(s): Harry TC. Source: Lancet. 2002 February 2; 359(9304): 447-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11844552&dopt=Abstract

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Infectivity tests in syphilis. 1969. Author(s): Turner TB, Hardy PH, Newman B. Source: Sexually Transmitted Infections. 2000 June; 76 Suppl 1: S7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10911848&dopt=Abstract

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Injecting drug users in Bangladesh: prevalence of syphilis, hepatitis, HIV and HIV subtypes. Author(s): Azim T, Bogaerts J, Yirrell DL, Banerjea AC, Sarker MS, Ahmed G, Amin MM, Rahman AS, Hussain AM. Source: Aids (London, England). 2002 January 4; 16(1): 121-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11741170&dopt=Abstract

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Intensive arsenotherapy of early syphilis. Author(s): Kampmeier RH. Source: Sexually Transmitted Diseases. 1982 January-March; 9(1): 48-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10328026&dopt=Abstract

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Interleukin 10 and its role in the regulation of the cell-mediated immune response in syphilis. Author(s): Lusiak M, Podwinska J. Source: Arch Immunol Ther Exp (Warsz). 2001; 49(6): 417-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11814235&dopt=Abstract

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Intestinal ulceration, obstruction, and haemorrhage in congenital syphilis. Author(s): Ajayi NA, Marven S, Kaschula RO, Millar A, Rode H. Source: Pediatric Surgery International. 1999 July; 15(5-6): 391-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10415295&dopt=Abstract

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Intractable epilepsy as the initial manifestation of neurosyphilis. Author(s): Phan TG, Somerville ER, Chen S. Source: Epilepsia. 1999 September; 40(9): 1309-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10487197&dopt=Abstract

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Investigation of isolated positive syphilis enzyme immunoassay (ICE Murex) results. Author(s): Ooi C, Robertson P, Donovan B. Source: International Journal of Std & Aids. 2002 November; 13(11): 761-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12437896&dopt=Abstract

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Is antenatal syphilis screening still cost effective in sub-Saharan Africa. Author(s): Terris-Prestholt F, Watson-Jones D, Mugeye K, Kumaranayake L, Ndeki L, Weiss H, Changalucha J, Todd J, Lisekie F, Gumodoka B, Mabey D, Hayes R. Source: Sexually Transmitted Infections. 2003 October; 79(5): 375-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14573832&dopt=Abstract

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Is increased surveillance for asymptomatic syphilis in an HIV outpatient department worthwhile? Author(s): Winston A, Hawkins D, Mandalia S, Boag F, Azadian B, Asboe D. Source: Sexually Transmitted Infections. 2003 June; 79(3): 257-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12794218&dopt=Abstract

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Is routine antenatal screening for syphilis useful? Author(s): Gharoro EP, Abedi HO. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2000 January; 68(1): 55-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10687840&dopt=Abstract

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Isolated episodes of status epilepticus as the manifestation of neurosyphilis: a case report. Author(s): Vojvodic NM, Sokic DV, Jankovic SM, Delic S. Source: Epilepsia. 2003 April; 44(4): 623. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12681015&dopt=Abstract

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Keratopathy from congenital syphilis. Author(s): Hariprasad SM, Moon SJ, Allen RC, Wilhelmus KR. Source: Cornea. 2002 August; 21(6): 608-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12131041&dopt=Abstract

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Keratosis lichenoides chronica mimicking verrucous secondary syphilis. Author(s): Jayaraman AG, Pomerantz D, Robinson-Bostom L. Source: Journal of the American Academy of Dermatology. 2003 September; 49(3): 511-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12963920&dopt=Abstract

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Laboratory methods of diagnosis of syphilis for the beginning of the third millennium. Author(s): Wicher K, Horowitz HW, Wicher V. Source: Microbes and Infection / Institut Pasteur. 1999 October; 1(12): 1035-49. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10617935&dopt=Abstract

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Lack of association of gestational trophoblastic diseases (GTD) with syphilis and AIDS. Author(s): Swapna E, Molykutty J, Rajalekshmy TN, Vijayasree SR, Krishnan NM, Prabha B. Source: Indian J Pathol Microbiol. 1998 July; 41(3): 277-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9805848&dopt=Abstract

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Lessons of syphilis for the age of AIDS. Author(s): Haburchak DR. Source: Pharos Alpha Omega Alpha Honor Med Soc. 2000 Summer; 63(3): 21-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11011561&dopt=Abstract

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Lichenoid secondary syphilis. Author(s): Carbia SG, Lagodin C, Abbruzzese M, Sevinsky L, Casco R, Casas J, Woscoff A. Source: International Journal of Dermatology. 1999 January; 38(1): 53-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10065612&dopt=Abstract

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Locally acquired heterosexual outbreak of syphilis in Bristol. Author(s): Battu VR, Horner PJ, Taylor PK, Jephcott AE, Egglestone SI. Source: Lancet. 1997 October 11; 350(9084): 1100-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10213571&dopt=Abstract

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London--the next battleground for syphilis? Author(s): Crook PD, Paine TC, Davis M, Fenton KA. Source: Commun Dis Public Health. 2002 June; 5(2): 163-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12166306&dopt=Abstract

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Looking back: congenital syphilis in 1905. Author(s): Scales WF. Source: J Miss State Med Assoc. 2002 April; 43(4): 132-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11989203&dopt=Abstract

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Low incidence of syphilis among factory workers in Ethiopia: effect of an intervention based on education and counselling. Author(s): Sahlu T, de Wit TR, Tsegaye A, Mekonnen Y, Beyene A, Hailu B, Coutinho RA, Fontanet A. Source: Sexually Transmitted Infections. 2002 April; 78(2): 123-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12081173&dopt=Abstract

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Lues and lupus: syphilis mimicking systemic lupus erythematosus (SLE). Author(s): Shatley MJ, Walker BL, McMurray RW. Source: Lupus. 2001; 10(4): 299-303. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11341108&dopt=Abstract

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Malignant syphilis: a review. Author(s): Kumar B, Muralidhar S. Source: Aids Patient Care and Stds. 1998 December; 12(12): 921-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11362063&dopt=Abstract

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Management issues in syphilis. Author(s): Pao D, Goh BT, Bingham JS. Source: Drugs. 2002; 62(10): 1447-61. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12093314&dopt=Abstract

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Manifestations of otosyphilis as visualized with computed tomography. Author(s): Sonne JE, Zeifer B, Linstrom C. Source: Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2002 September; 23(5): 806-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12218639&dopt=Abstract

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Mass treatment/prophylaxis during an outbreak of infectious syphilis in Vancouver, British Columbia. Author(s): Rekart M, Patrick D, Jolly A, Wong T, Morshed M, Jones H, Montgomery C, Knowles L, Chakraborty N, Maginley J. Source: Can Commun Dis Rep. 2000 June 15; 26(12): 101-5. English, French. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10932390&dopt=Abstract

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Maternal and congenital syphilis in Bolivia, 1996: prevalence and risk factors. Author(s): Southwick KL, Blanco S, Santander A, Estenssoro M, Torrico F, Seoane G, Brady W, Fears M, Lewis J, Pope V, Guarner J, Levine WC. Source: Bulletin of the World Health Organization. 2001; 79(1): 33-42. Epub 2003 November 05. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11217665&dopt=Abstract

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Membranous nephropathy in a patient with syphilis and Hashimoto's disease. Author(s): Munoz de Bustillo E, Rivera F, Trigueros M, Olivares J. Source: Nephron. 2000 November; 86(3): 344-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11096294&dopt=Abstract

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Meningovascular syphilis: a vascular syndrome with typical features? Author(s): Pezzini A, Gulletta M, Pinelli L, Marangoni A, El-Hamad I, Gasparotti R, Padovani A. Source: Cerebrovascular Diseases (Basel, Switzerland). 2001; 11(4): 352-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11385218&dopt=Abstract

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Mesiotemporal T2-weighted hyperintensity: neurosyphilis mimicking herpes encephalitis. Author(s): Bash S, Hathout GM, Cohen S. Source: Ajnr. American Journal of Neuroradiology. 2001 February; 22(2): 314-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11156776&dopt=Abstract

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Missed opportunities for congenital syphilis prevention in an urban southeastern hospital. Author(s): Warner L, Rochat RW, Fichtner RR, Stoll BJ, Nathan L, Toomey KE. Source: Sexually Transmitted Diseases. 2001 February; 28(2): 92-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11234792&dopt=Abstract

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Molecular diagnosis of syphilis: the Schaudinn-Hoffmann lymph-node biopsy. Author(s): Kouznetsov AV, Prinz JC. Source: Lancet. 2002 August 3; 360(9330): 388-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12241783&dopt=Abstract

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Molecular subtyping of Treponema pallidum in an Arizona County with increasing syphilis morbidity: use of specimens from ulcers and blood. Author(s): Sutton MY, Liu H, Steiner B, Pillay A, Mickey T, Finelli L, Morse S, Markowitz LE, St Louis ME. Source: The Journal of Infectious Diseases. 2001 June 1; 183(11): 1601-6. Epub 2001 May 01. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11343208&dopt=Abstract

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More than fact and fiction. Cultural memory and the Tuskegee Syphilis Study. Author(s): Reverby SM. Source: The Hastings Center Report. 2001 September-October; 31(5): 22-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12974115&dopt=Abstract

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Mortality associated with congenital syphilis in the United States, 1992-1998. Author(s): Gust DA, Levine WC, St Louis ME, Braxton J, Berman SM. Source: Pediatrics. 2002 May; 109(5): E79-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11986485&dopt=Abstract

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Moving toward the eradication of syphilis. Author(s): Thomas RJ, MacDonald MR, Lenart M, Calvert WB, Morrow R. Source: Military Medicine. 2002 June; 167(6): 489-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12099085&dopt=Abstract

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Mucocutaneous manifestations of secondary syphilis in north Indian patients: a changing scenario? Author(s): Kumar B, Gupta S, Muralidhar S. Source: The Journal of Dermatology. 2001 March; 28(3): 137-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11349464&dopt=Abstract

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Multifocal asymptomatic retinal pigment epithelial detachments in neurosyphilis. Author(s): Anand S, Mushin AS. Source: Eye (London, England). 2003 May; 17(4): 524-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12802355&dopt=Abstract

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Multiple annular plaques on the face of a middle-aged woman. Diagnosis: secondary syphilis. Author(s): Carlson-Sweet KL, Wyatt EL, Sutter SH. Source: Archives of Dermatology. 2000 July; 136(7): 925-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10890999&dopt=Abstract

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Multiple plaques on the face and neck of a middle-aged man. Diagnosis: secondary syphilis. Author(s): Erisir F, Senocak D, Inci E, Guclu E. Source: Ear, Nose, & Throat Journal. 2002 January; 81(1): 55-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11816392&dopt=Abstract

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Mumbai disease in far western Nepal: HIV infection and syphilis among male migrant-returnees and non-migrants. Author(s): Poudel KC, Okumura J, Sherchand JB, Jimba M, Murakami I, Wakai S. Source: Tropical Medicine & International Health : Tm & Ih. 2003 October; 8(10): 933-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14516305&dopt=Abstract

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My choice: Infectivity tests in syphilis. Author(s): Turner TB. Source: Sexually Transmitted Infections. 2000 June; 76 Suppl 1: S8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10950617&dopt=Abstract

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Networks of persons with syphilis and at risk for syphilis in Louisiana: evidence of core transmitters. Author(s): Rosenberg D, Moseley K, Kahn R, Kissinger P, Rice J, Kendall C, Coughlin S, Farley TA. Source: Sexually Transmitted Diseases. 1999 February; 26(2): 108-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10029986&dopt=Abstract

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Neurosyphilis as a cause of facial and vestibulocochlear nerve dysfunction: MR imaging features. Author(s): Smith MM, Anderson JC. Source: Ajnr. American Journal of Neuroradiology. 2000 October; 21(9): 1673-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11039349&dopt=Abstract

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Neurosyphilis during the AIDS epidemic, New Orleans, 1990-1997. Author(s): Inungu J, Morse A, Gordon C. Source: The Journal of Infectious Diseases. 1998 October; 178(4): 1229. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9806069&dopt=Abstract

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Neurosyphilis in elderly patients. Author(s): Castilla-Guerra L, Fernandez-Moreno MC, Izquierdo G. Source: The Journal of Neuropsychiatry and Clinical Neurosciences. 1999 Spring; 11(2): 287. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10334005&dopt=Abstract

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Neurosyphilis in musicians and composers. Author(s): Roos KL. Source: Seminars in Neurology. 1999; 19 Suppl 1: 35-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10718526&dopt=Abstract

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Neurosyphilis presenting as herpes simplex encephalitis. Author(s): Szilak I, Marty F, Helft J, Soeiro R. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2001 April 1; 32(7): 1108-9. Epub 2001 March 20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11264042&dopt=Abstract

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Neurosyphilis presenting as progressive supranuclear palsy. Author(s): Murialdo A, Marchese R, Abbruzzese G, Tabaton M, Michelozzi G, Schiavoni S. Source: Movement Disorders : Official Journal of the Movement Disorder Society. 2000 July; 15(4): 730-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10928586&dopt=Abstract

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Neurosyphilis presenting as schizophrenialike psychosis. Author(s): Kohler CG, Pickholtz J, Ballas C. Source: Neuropsychiatry, Neuropsychology, and Behavioral Neurology. 2000 October; 13(4): 297-302. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11186166&dopt=Abstract

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Neurosyphilis showing transient global amnesia-like attacks and magnetic resonance imaging abnormalities mainly in the limbic system. Author(s): Fujimoto H, Imaizumi T, Nishimura Y, Miura Y, Ayabe M, Shoji H, Abe T. Source: Intern Med. 2001 May; 40(5): 439-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11393420&dopt=Abstract

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Neurosyphilis. Author(s): Schiff E, Lindberg M. Source: Southern Medical Journal. 2002 September; 95(9): 1083-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12356119&dopt=Abstract

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Neurosyphilis. Screening does sometimes reveal an infectious cause of dementia. Author(s): Polsky I, Samuels SC. Source: Geriatrics. 2001 March; 56(3): 60-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11252762&dopt=Abstract

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Neurosyphilis: how do you know, and what do you do? Author(s): Henry K, Harwell JI. Source: Aids Clin Care. 2002 October; 14(10): 92-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12765137&dopt=Abstract

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Neurosyphilis: is it really a reversible cause of dementia? Author(s): Margolin EG. Source: Geriatrics. 2001 May; 56(5): 16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11373946&dopt=Abstract

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New HIV cases attributable to syphilis in the USA: estimates from a simplified transmission model. Author(s): Chesson HW, Pinkerton SD, Irwin KL, Rein D, Kassler WJ. Source: Aids (London, England). 1999 July 30; 13(11): 1387-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10449293&dopt=Abstract

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New tests for syphilis: rational design of a PCR method for detection of Treponema pallidum in clinical specimens using unique regions of the DNA polymerase I gene. Author(s): Liu H, Rodes B, Chen CY, Steiner B. Source: Journal of Clinical Microbiology. 2001 May; 39(5): 1941-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11326018&dopt=Abstract

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No positive tests for syphilis in 6 years of observation among heroin drug users in north-eastern Italy. Author(s): Lugoboni F, Quaglio G, Mezzelani P, Lechi A. Source: Addiction (Abingdon, England). 2002 January; 97(1): 104-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11895263&dopt=Abstract

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Nodular secondary syphilis. Author(s): Dave S, Gopinath DV, Thappa DM. Source: Dermatology Online Journal [electronic Resource]. 2003 February; 9(1): 9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12639467&dopt=Abstract

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Nodular tertiary syphilis mimicking granuloma annulare. Author(s): Wu SJ, Nguyen EQ, Nielsen TA, Pellegrini AE. Source: Journal of the American Academy of Dermatology. 2000 February; 42(2 Pt 2): 378-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10640938&dopt=Abstract

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Nonconvulsive status epilepticus resulting from Jarisch-Herxheimer reaction in a patient with neurosyphilis. Author(s): Kojan S, Van Ness PC, Diaz-Arrastia R. Source: Clin Electroencephalogr. 2000 July; 31(3): 138-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10923200&dopt=Abstract

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Nosocomial transmission of syphilis during haemodialysis in a developing country. Author(s): Saxena AK, Panhotra BR, Naguib M, Uzzaman W, Al MK. Source: Scandinavian Journal of Infectious Diseases. 2002; 34(2): 88-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11928859&dopt=Abstract

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Ocular syphilis. Author(s): Aldave AJ, King JA, Cunningham ET Jr. Source: Current Opinion in Ophthalmology. 2001 December; 12(6): 433-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11734683&dopt=Abstract

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On-site rapid plasma reagin screening for syphilis in pregnancy. Author(s): Woods D, Roditi D. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1998 September; 88(9): 1051, 1054. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9798487&dopt=Abstract

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Oral manifestation of tertiary syphilis: case report. Author(s): Aarestrup FM, Vieira BJ. Source: Brazilian Dental Journal. 1999; 10(2): 117-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10863399&dopt=Abstract

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Origin of syphilis. Author(s): Baker SR, Lum C. Source: Ajr. American Journal of Roentgenology. 1999 April; 172(4): 1138-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10587166&dopt=Abstract

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Otolaryngologic manifestations of acquired syphilis. Author(s): Kleidermacher P, Vito KJ, Strome M. Source: Otolaryngology and Head and Neck Surgery. 1998 October; 119(4): 399-402. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9782000&dopt=Abstract

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Otoneurosyphilis masquerading as neurofibromatosis type II. Author(s): Ahmad I, Lee WC. Source: Orl; Journal for Oto-Rhino-Laryngology and Its Related Specialties. 1999 January-February; 61(1): 37-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9892868&dopt=Abstract

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Parenchymatous neurosyphilis. Author(s): Lauria G, Erbetta A, Pareyson D, Sghirlanzoni A. Source: Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2001 June; 22(3): 281-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11731886&dopt=Abstract

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Partner notification for HIV and syphilis: effects on sexual behaviors and relationship stability. Author(s): Kissinger PJ, Niccolai LM, Magnus M, Farley TA, Maher JE, RichardsonAlston G, Dorst D, Myers L, Peterman TA. Source: Sexually Transmitted Diseases. 2003 January; 30(1): 75-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12514447&dopt=Abstract

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Performance of the rapid plasma reagin and the rapid syphilis screening tests in the diagnosis of syphilis in field conditions in rural Africa. Author(s): West B, Walraven G, Morison L, Brouwers J, Bailey R. Source: Sexually Transmitted Infections. 2002 August; 78(4): 282-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12181468&dopt=Abstract

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Perianal ulcer and rash. Secondary syphilis. Author(s): van Assen S, van Kasteren ME. Source: The Netherlands Journal of Medicine. 2003 March; 61(3): 82, 98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12765228&dopt=Abstract

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Persons with early syphilis identified through blood or plasma donation screening in the United States. Author(s): Gardella C, Marfin AA, Kahn RH, Swint E, Markowitz LE. Source: The Journal of Infectious Diseases. 2002 February 15; 185(4): 545-9. Epub 2002 January 22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11865408&dopt=Abstract

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Perspectives of low-income African Americans on syphilis and HIV: implications for prevention. Author(s): Okwumabua JO, Glover V, Bolden D, Edwards S. Source: Journal of Health Care for the Poor and Underserved. 2001 November; 12(4): 474-89. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11688197&dopt=Abstract

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Placental histopathology of congenital syphilis. Author(s): Sheffield JS, Sanchez PJ, Wendel GD Jr, Fong DW, Margraf LR, Zeray F, McIntire DD, Barton Rogers B. Source: Obstetrics and Gynecology. 2002 July; 100(1): 126-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12100814&dopt=Abstract

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Posterior segment manifestations of active ocular syphilis, their response to a neurosyphilis regimen of penicillin therapy, and the influence of human immunodeficiency virus status on response. Author(s): Browning DJ. Source: Ophthalmology. 2000 November; 107(11): 2015-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11054325&dopt=Abstract

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Potential opportunities to enhance syphilis surveillance system. Author(s): Huang J, Bailey SB, Perkey B. Source: Tenn Med. 2002 August; 95(8): 331-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12174755&dopt=Abstract

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Prevalence monitoring in syphilis surveillance: results from a multicenter research program. Author(s): Finelli L, Farley TP, Gibson JJ, Langley C, Hwang LY, Levine WC. Source: Sexually Transmitted Diseases. 2002 December; 29(12): 769-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12466718&dopt=Abstract

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Prevalence of circulating Treponema pallidum DNA and RNA in blood donors with confirmed-positive syphilis tests. Author(s): Orton SL, Liu H, Dodd RY, Williams AE; ARCNET Epidemiology Group. Source: Transfusion. 2002 January; 42(1): 94-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11896319&dopt=Abstract

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Prevalence of hepatitis B, hepatitis C, syphilis and HIV in Georgian blood donors. Author(s): Butsashvili M, Tsertsvadze T, McNutt LA, Kamkamidze G, Gvetadze R, Badridze N. Source: European Journal of Epidemiology. 2001; 17(7): 693-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12086085&dopt=Abstract

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Prevalence of herpes simplex type 2 and syphilis serology among young adults in a rural Gambian community. Author(s): Shaw M, van der Sande M, West B, Paine K, Ceesay S, Bailey R, Walraven G, Morison L, McAdam K. Source: Sexually Transmitted Infections. 2001 October; 77(5): 358-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11588283&dopt=Abstract

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Prevalence of syphilis in pregnancy in Addis Ababa. Author(s): Kebede E, Chamiso B. Source: East Afr Med J. 2000 April; 77(4): 212-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12858906&dopt=Abstract

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Primary and secondary syphilis--United States, 2002. Author(s): Centers for Disease Control and Prevention (CDC). Source: Mmwr. Morbidity and Mortality Weekly Report. 2003 November 21; 52(46): 1117-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14627949&dopt=Abstract

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Primary syphilis remains a cause of oral ulceration. Author(s): Alam F, Argiriadou AS, Hodgson TA, Kumar N, Porter SR. Source: British Dental Journal. 2000 October 14; 189(7): 352-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11081944&dopt=Abstract

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Protection against syphilis correlates with specificity of antibodies to the variable regions of Treponema pallidum repeat protein K. Author(s): Morgan CA, Lukehart SA, Van Voorhis WC. Source: Infection and Immunity. 2003 October; 71(10): 5605-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500480&dopt=Abstract

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Pseudo-Argyll Robertson pupil associated with neurosyphilis: case report. Author(s): Hama Y, Nakamura R, Kusano S. Source: Canadian Association of Radiologists Journal = Journal L'association Canadienne Des Radiologistes. 2000 June; 51(3): 186-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10914085&dopt=Abstract

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Pulmonary abscesses in congenital syphilis. Author(s): Bell C, Taxy J. Source: Archives of Pathology & Laboratory Medicine. 2002 April; 126(4): 484-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11900580&dopt=Abstract

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Pyrexia of unknown origin in HIV infection and the resurgence of syphilis. Author(s): Allen S, Nelson M. Source: International Journal of Std & Aids. 2002 December; 13(12): 860. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12537746&dopt=Abstract

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Rapid public health interventions in response to an outbreak of syphilis in Los Angeles. Author(s): Chen JL, Kodagoda D, Lawrence AM, Kerndt PR. Source: Sexually Transmitted Diseases. 2002 May; 29(5): 277-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11984444&dopt=Abstract

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Recent declines in reported syphilis rates in eastern Europe and central Asia: are the epidemics over? Author(s): Riedner G, Dehne KL, Gromyko A. Source: Sexually Transmitted Infections. 2000 October; 76(5): 363-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11141852&dopt=Abstract

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Re-emergence of syphilis. Author(s): Waugh MA. Source: Hosp Med. 2000 July; 61(7): 454-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11091798&dopt=Abstract

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Re-emergence of syphilis. Author(s): Thin RN. Source: Hosp Med. 2000 September; 61(9): 675. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11048617&dopt=Abstract

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Re-emergence of syphilis. Author(s): Kinghorn G. Source: Hosp Med. 2000 September; 61(9): 675. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11048616&dopt=Abstract

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Re-emerging syphilis in gay men: a case-control study of behavioural risk factors and HIV status. Author(s): Bellis MA, Cook P, Clark P, Syed Q, Hoskins A. Source: Journal of Epidemiology and Community Health. 2002 March; 56(3): 235-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11854349&dopt=Abstract

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Re-emerging syphilis in the UK: a behavioural analysis of infected individuals. Author(s): Cook PA, Clark P, Bellis MA, Ashton JR, Syed Q, Hoskins A, Higgins SP, Sukthankar A, Chandiok S. Source: Commun Dis Public Health. 2001 December; 4(4): 253-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12109391&dopt=Abstract

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Relapse of early syphilis on first line treatment. Author(s): Goorney B, Leahy M. Source: International Journal of Std & Aids. 2002 October; 13(10): 722-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12396545&dopt=Abstract

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Resolving the common clinical dilemmas of syphilis. Author(s): Birnbaum NR, Goldschmidt RH, Buffett WO. Source: American Family Physician. 1999 April 15; 59(8): 2233-40, 2245-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10221308&dopt=Abstract

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Responding to a community outbreak of syphilis by targeting sex partner meeting location: an example of a risk-space intervention. Author(s): Michaud JM, Ellen J, Johnson SM, Rompalo A. Source: Sexually Transmitted Diseases. 2003 July; 30(7): 533-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12838079&dopt=Abstract

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Response to standard syphilis treatment in patients infected with the human immunodeficiency virus. Author(s): Bordon J, Martinez-Vazquez C, de la Fuente-Aguado J, Sopena B, OcampoHermida A, Nunez-Torron J, Rodriguez-Sousa T, Alvarez-Fernandez M, del Blanco T. Source: European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 1999 October; 18(10): 72932. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10584901&dopt=Abstract

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Resurgence in gonorrhoea and syphilis in UK might be due to cyclic patterns of variations. Author(s): Dimitrov BD. Source: Journal of Public Health Medicine. 1999 March; 21(1): 117-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10321872&dopt=Abstract

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Resurgence of syphilis in England. Author(s): O'Farrell N. Source: Sexually Transmitted Infections. 2002 August; 78(4): 308. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12181481&dopt=Abstract

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Resurgence of syphilis in England: time for more radical and nationally coordinated approaches. Author(s): Fenton KA, Nicoll A, Kinghorn G. Source: Sexually Transmitted Infections. 2001 October; 77(5): 309-10. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11588268&dopt=Abstract

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Rethinking the Tuskegee Syphilis Study. Nurse Rivers, silence and the meaning of treatment. Author(s): Reverby SM. Source: Nurs Hist Rev. 1999; 7: 3-28. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10063364&dopt=Abstract

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Risk factors for active syphilis and TPHA seroconversion in a rural African population. Author(s): Todd J, Munguti K, Grosskurth H, Mngara J, Changalucha J, Mayaud P, Mosha F, Gavyole A, Mabey D, Hayes R. Source: Sexually Transmitted Infections. 2001 February; 77(1): 37-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11158690&dopt=Abstract

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Risk factors for syphilis among HIV-1 infected pregnant women in Dar es Salaam, Tanzania. Author(s): Urassa WK, Kapiga SH, Msamanga GI, Antelman G, Coley J, Fawzi WW. Source: Afr J Reprod Health. 2001 December; 5(3): 54-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12471929&dopt=Abstract

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Risk factors for syphilis among incarcerated women in Rhode Island. Author(s): Rich JD, Hou JC, Charuvastra A, Towe CW, Lally M, Spaulding A, Bandy U, Donnelly EF, Rompalo A. Source: Aids Patient Care and Stds. 2001 November; 15(11): 581-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11788068&dopt=Abstract

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Routine antenatal syphilis screening--a case against. Author(s): Obisesan KA, Ahmed Y. Source: Afr J Med Med Sci. 1999 September-December; 28(3-4): 185-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11205828&dopt=Abstract

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Rural sex work in Cambodia: work characteristics, risk behaviours, HIV, and syphilis. Author(s): Sopheab H, Gorbach PM, Gloyd S, Leng HB. Source: Sexually Transmitted Infections. 2003 August; 79(4): E2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12902610&dopt=Abstract

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Secondary syphilis presenting as pseudolymphoma of the skin. Author(s): McComb ME, Telang GH, Vonderheid EC. Source: Journal of the American Academy of Dermatology. 2003 August; 49(2 Suppl Case Reports): S174-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12894114&dopt=Abstract

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Secondary syphilis simulating oral hairy leukoplakia. Author(s): Aquilina C, Viraben R, Denis P. Source: Journal of the American Academy of Dermatology. 2003 October; 49(4): 749-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14512934&dopt=Abstract

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Sequence diversity of Treponema pallidum subsp. pallidum tprK in human syphilis lesions and rabbit-propagated isolates. Author(s): LaFond RE, Centurion-Lara A, Godornes C, Rompalo AM, Van Voorhis WC, Lukehart SA. Source: Journal of Bacteriology. 2003 November; 185(21): 6262-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14563860&dopt=Abstract

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Serodiagnosis of syphilis: antibodies to recombinant Tp0453, Tp92, and Gpd proteins are sensitive and specific indicators of infection by Treponema pallidum. Author(s): Van Voorhis WC, Barrett LK, Lukehart SA, Schmidt B, Schriefer M, Cameron CE. Source: Journal of Clinical Microbiology. 2003 August; 41(8): 3668-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12904373&dopt=Abstract

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Single photon emission CT perfusion imaging of cerebral blood flow of early syphilis patients. Author(s): Shi X, Wu J, Liu Z, Tang J, Su Y. Source: Chinese Medical Journal. 2003 July; 116(7): 1051-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12890382&dopt=Abstract

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State laws regarding prenatal syphilis screening in the United States. Author(s): Hollier LM, Hill J, Sheffield JS, Wendel GD Jr. Source: American Journal of Obstetrics and Gynecology. 2003 October; 189(4): 1178-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14586375&dopt=Abstract

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Strategic options for antenatal screening for syphilis in the United Kingdom: a cost effectiveness analysis. Author(s): Connor N, Roberts J, Nicoll A. Source: Journal of Medical Screening. 2000; 7(1): 7-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10807140&dopt=Abstract

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Strategies for syphilis prevention: findings from surveys in a high-incidence area. Author(s): Farley TA, Kahn RH, Johnson G, Cohen DA. Source: Sexually Transmitted Diseases. 2000 July; 27(6): 305-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10907903&dopt=Abstract

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Syphilis and gonorrhoea in the Baltic countries. Author(s): Rubins A, Rubins S, Jakabsone I. Source: Sexually Transmitted Infections. 2000 June; 76(3): 214. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10961203&dopt=Abstract

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Syphilis and orthostatic shaking limbs. Author(s): Brotman DJ, Fotuhi M. Source: Lancet. 2000 November 18; 356(9243): 1734. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11095262&dopt=Abstract

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Syphilis and otolaryngology. Author(s): Pletcher SD, Cheung SW. Source: Otolaryngologic Clinics of North America. 2003 August; 36(4): 595-605, Vi. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14567055&dopt=Abstract

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Syphilis in pregnancy. Author(s): Genc M, Ledger WJ. Source: Sexually Transmitted Infections. 2000 April; 76(2): 73-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10858706&dopt=Abstract

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Syphilis prevalence has rapidly decreased in South Korea. Author(s): Cho YH, Kim HO, Lee JB, Lee MG. Source: Sexually Transmitted Infections. 2003 August; 79(4): 323-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12902586&dopt=Abstract

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Syphilis referred from complementary medicine therapy. Author(s): Davies S, O'Farrell N. Source: International Journal of Std & Aids. 2003 September; 14(9): 640-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14511505&dopt=Abstract

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Syphilis screening programme in Athens, 1974-98. Author(s): Georgala S, Schulpis KH, Georgala C, Karikas GA. Source: Sexually Transmitted Infections. 2000 February; 76(1): 53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10817072&dopt=Abstract

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Syphilis specific antibodies in newborn infants in Lower Saxony, Germany 19932001. Author(s): Steuerwald U, Sander J, Sander S, Janzen N, Andree M. Source: Sexually Transmitted Infections. 2003 August; 79(4): 351-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12902606&dopt=Abstract

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Syphilis therapy. Author(s): Barrazza V. Source: International Journal of Dermatology. 2000 October; 39(10): 799. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11095206&dopt=Abstract

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Syphilis treatment notes. Author(s): Scahill MP. Source: The Nurse Practitioner. 2000 July; 25(7): 11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10916825&dopt=Abstract

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Syphilis: a barometer of community health. Author(s): Wasserheit JN. Source: Sexually Transmitted Diseases. 2000 July; 27(6): 311-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10907904&dopt=Abstract

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Syphilis: an update. Author(s): Goldmeier D, Guallar C. Source: Clinical Medicine (London, England). 2003 May-June; 3(3): 209-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12848252&dopt=Abstract

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Targeted mass treatment for syphilis with oral azithromycin. Author(s): Rekart ML, Patrick DM, Chakraborty B, Maginley JJ, Jones HD, Bajdik CD, Pourbohloul B, Brunham RC. Source: Lancet. 2003 January 25; 361(9354): 313-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12559870&dopt=Abstract

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Tertiary syphilis. Author(s): Goldmeier D. Source: Sexually Transmitted Infections. 2000 June; 76(3): 222-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10961213&dopt=Abstract

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The cost-effectiveness of single-dose azithromycin for treatment of incubating syphilis. Author(s): Blandford JM, Gift TL. Source: Sexually Transmitted Diseases. 2003 June; 30(6): 502-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12782951&dopt=Abstract

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The epidemiology of syphilis in pregnancy. Author(s): Lumbiganon P, Piaggio G, Villar J, Pinol A, Bakketeig L, Bergsjo P, AlMazrou Y, Ba'aqeel H, Belizan JM, Farnot U, Carroli G, Berendes H; WHO Antenatal Care Trial Research Group. Source: International Journal of Std & Aids. 2002 July; 13(7): 486-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12171669&dopt=Abstract

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The legacy of the Tuskegee syphilis experiments for emergency exception from informed consent. Author(s): Schmidt TA. Source: Annals of Emergency Medicine. 2003 January; 41(1): 79-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12514686&dopt=Abstract

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The plague busters. Stopping a new and deadly mix of syphilis and HIV. Author(s): Levine S. Source: U.S. News & World Report. 2003 June 2; 134(19): 36, 39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12800328&dopt=Abstract

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The recent increase of syphilis cases in Lyon University hospitals Is mainly observed in HIV-infected patients: descriptive data from a laboratory-based surveillance system. Author(s): Giard M, Queyron PC, Ritter J, Peyramond D, Trepo C, Miailhes P, Chidiac C, Touraine JL, Livrozet JM, Boibieux A, Fabry J, Allard R, Vanhems P. Source: Journal of Acquired Immune Deficiency Syndromes (1999). 2003 December 1; 34(4): 441-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14615665&dopt=Abstract

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The social pathology of syphilis in Africans. 1949. Author(s): Kark SL. Source: International Journal of Epidemiology. 2003 April; 32(2): 181-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12714531&dopt=Abstract

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The Tuskegee syphilis study and consent. Author(s): White RM. Source: Annals of Emergency Medicine. 2003 September; 42(3): 430-1; Author Reply 431. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12956140&dopt=Abstract

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The Tuskegee syphilis study. Author(s): White RM. Source: The Hastings Center Report. 2002 November-December; 32(6): 4-5; Author Reply 5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12494853&dopt=Abstract

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TORCH Infections. Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections. Author(s): Stegmann BJ, Carey JC. Source: Curr Womens Health Rep. 2002 August; 2(4): 253-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12150751&dopt=Abstract

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Tracing a syphilis outbreak through cyberspace. Author(s): Klausner JD, Wolf W, Fischer-Ponce L, Zolt I, Katz MH. Source: Jama : the Journal of the American Medical Association. 2000 July 26; 284(4): 447-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10904507&dopt=Abstract

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Trancranial Doppler monitoring of response to therapy for meningovascular syphilis. Author(s): Kelley RE, Minagar A, Kelley BJ, Brunson R. Source: Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging. 2003 January; 13(1): 85-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12593138&dopt=Abstract

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Treatment of early syphilis with azithromycin. Author(s): Gruber F, Kastelan M, Cabrijan L, Simonic E, Brajac I. Source: Journal of Chemotherapy (Florence, Italy). 2000 June; 12(3): 240-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10877520&dopt=Abstract

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Treatment of neurosyphilis with ceftriaxone. Author(s): Shann S, Wilson J. Source: Sexually Transmitted Infections. 2003 October; 79(5): 415-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14573840&dopt=Abstract

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Treatment of syphilis 2001: nonpregnant adults. Author(s): Augenbraun MH. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2002 October 15; 35(Suppl 2): S187-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12353205&dopt=Abstract

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Treatment of syphilis in pregnancy and prevention of congenital syphilis. Author(s): Wendel GD Jr, Sheffield JS, Hollier LM, Hill JB, Ramsey PS, Sanchez PJ. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2002 October 15; 35(Suppl 2): S200-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12353207&dopt=Abstract

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Trends in HIV, gonorrhoea, and syphilis. Screening for neurosyphilis is recommended. Author(s): Solaro C, De Maria A, Primavera A. Source: Bmj (Clinical Research Ed.). 2002 August 31; 325(7362): 494. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12202339&dopt=Abstract

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Trends in HIV, gonorrhoea, and syphilis. Sexual health services in general practice can be improved. Author(s): Spence D. Source: Bmj (Clinical Research Ed.). 2002 August 31; 325(7362): 494. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12211234&dopt=Abstract

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Treponema pallidum surface immunofluorescence assay for serologic diagnosis of syphilis. Author(s): Marangoni A, Sambri V, Storni E, D'Antuono A, Negosanti M, Cevenini R. Source: Clinical and Diagnostic Laboratory Immunology. 2000 May; 7(3): 417-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10799455&dopt=Abstract

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Unraveling the Tuskegee Study of Untreated Syphilis. Author(s): White RM. Source: Archives of Internal Medicine. 2000 March 13; 160(5): 585-98. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10724044&dopt=Abstract

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Unreliability of syphilis screening tests. Author(s): Reeves RR. Source: Otolaryngology and Head and Neck Surgery. 2000 January; 122(1): 156. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10629512&dopt=Abstract

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Unusual presentation of congenital syphilis. Author(s): Simmank KC, Pettifor JM. Source: Annals of Tropical Paediatrics. 2000 June; 20(2): 105-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10945059&dopt=Abstract

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Unusual presentation of secondary syphilis in 2 HIV-1 positive patients. Author(s): Liotta EA, Turiansky GW, Berberian BJ, Sulica VI, Tomaszewski MM. Source: Cutis; Cutaneous Medicine for the Practitioner. 2000 November; 66(5): 383-6, 389. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11107526&dopt=Abstract

•

Update on syphilis: resurgence of an old problem. Author(s): Golden MR, Marra CM, Holmes KK. Source: Jama : the Journal of the American Medical Association. 2003 September 17; 290(11): 1510-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13129993&dopt=Abstract

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US effort to eliminate syphilis moving forward. Author(s): Mitka M. Source: Jama : the Journal of the American Medical Association. 2000 March 22-29; 283(12): 1555-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10735376&dopt=Abstract

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Use of directly observed azithromycin treatment for syphilis in a homeless woman. Author(s): Campos-Outcalt D, Hurwitz S, Mickey T. Source: Sexually Transmitted Diseases. 2002 June; 29(6): 372. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12035029&dopt=Abstract

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Use of synthetic cardiolipin and lecithin in the antigen used by the venereal disease research laboratory test for serodiagnosis of syphilis. Author(s): Castro AR, Morrill WE, Shaw WA, Gale DC, Park MM, Peregrino-Ferreira LA, Bazzo ML, Pope V. Source: Clinical and Diagnostic Laboratory Immunology. 2000 July; 7(4): 658-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10882668&dopt=Abstract

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Usefulness of partner notification for syphilis control. Author(s): Kohl KS, Farley TA, Ewell J, Scioneaux J. Source: Sexually Transmitted Diseases. 1999 April; 26(4): 201-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10225586&dopt=Abstract

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Validation of the INNO-LIA syphilis kit as a confirmatory assay for Treponema pallidum antibodies. Author(s): Ebel A, Vanneste L, Cardinaels M, Sablon E, Samson I, De Bosschere K, Hulstaert F, Zrein M. Source: Journal of Clinical Microbiology. 2000 January; 38(1): 215-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10618090&dopt=Abstract

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Western immunoblotting with five Treponema pallidum recombinant antigens for serologic diagnosis of syphilis. Author(s): Sambri V, Marangoni A, Eyer C, Reichhuber C, Soutschek E, Negosanti M, D'Antuono A, Cevenini R. Source: Clinical and Diagnostic Laboratory Immunology. 2001 May; 8(3): 534-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11329453&dopt=Abstract

•

What is your diagnosis? Secondary syphilis. Author(s): Pichardo RO, Lu D, Sangueza OP, Tucker R. Source: The American Journal of Dermatopathology. 2002 December; 24(6): 503-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12481770&dopt=Abstract

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What's driving an epidemic? The spread of syphilis along an interstate highway in rural North Carolina. Author(s): Cook RL, Royce RA, Thomas JC, Hanusa BH. Source: American Journal of Public Health. 1999 March; 89(3): 369-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10076487&dopt=Abstract

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CHAPTER 2. NUTRITION AND SYPHILIS Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and syphilis.

Finding Nutrition Studies on Syphilis The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “syphilis” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “syphilis” (or a synonym): •

Eradication of endemic syphilis in Bosnia. Author(s): Department of Dermatology, University of Sarajevo, Yugoslavia. Source: Arslanagic, N Bokonjic, M Macanovic, K Genitourin-Med. 1989 January; 65(1): 47 0266-4348

•

Extensive nodular secondary syphilis. Author(s): Division of Dermatology, Ottawa General Hospital, Ontario, Canada. Source: Sapra, S Weatherhead, L Arch-Dermatol. 1989 December; 125(12): 1666-9 0003987X

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From mercury to malaria to penicillin: the history of the treatment of syphilis at the Mayo Clinic--1916-1955. Author(s): Division of Infectious Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905. Source: Sartin, J S Perry, H O J-Am-Acad-Dermatol. 1995 February; 32(2 Pt 1): 255-61 0190-9622

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Neurosyphilis, or chronic heavy metal poisoning: Karen Blixen's lifelong disease. Author(s): Department of Dermatology and Venereology, Bispebjerg Hospital, Bispebjerg Bakke, Copenhagen, Denmark. Source: Weismann, K Sex-Transm-Dis. 1995 May-June; 22(3): 137-44 0148-5717

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Nodular tertiary syphilis mimicking granuloma annulare. Author(s): Division of Dermatology, The Ohio State University, Columbus 43210, USA. Source: Wu, S J Nguyen, E Q Nielsen, T A Pellegrini, A E J-Am-Acad-Dermatol. 2000 February; 42(2 Pt 2): 378-80 0190-9622

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Ocular manifestations of syphilis. Author(s): Optometry Service, Veterans Administration, Boston, MA 02108. Source: Tierney, D W J-Am-Optom-Assoc. 1989 June; 60(6): 463-6 0003-0244

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Pathology of congenital syphilis in rabbits. Source: Froberg, M.K. Fitzgerald, T.J. Hamilton, T.R. Hamilton, B. Zarabi, M. Infectimmun. Washington, D.C., American Society for Microbiology. November 1993. volume 61 (11) page 4743-4749. 0019-9567

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Prostaglandins in experimental syphilis: treponemes stimulate adherent spleen cells to secrete prostaglandin E2, and indomethacin upregulates immune functions. Author(s): Department of Medical Microbiology, School of Medicine, University of Minnesota, Duluth 55812. Source: Fitzgerald, T J Tomai, M A Trachte, G J Rice, T Infect-Immun. 1991 January; 59(1): 143-9 0019-9567

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Syphilis superinfection activates expression of human immunodeficiency virus I in latently infected rabbits. Author(s): Department of Pathology, Medical School, University of Texas Health Science Center, Houston 77030. Source: Tseng, C K Hughes, M A Hsu, P L Mahoney, S Duvic, M Sell, S Am-J-Pathol. 1991 May; 138(5): 1149-64 0002-9440

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The group-specific protein marker: a possible indicator of syphilis, not human immunodeficiency virus infection. Author(s): Bureau of Microbiology, Department of National Health and Welfare, Ottawa, Tunney's Pasture, Ont. Source: Pollard, D R Gill, P Day, A CMAJ. 1988 June 1; 138(11): 1013-5 0820-3946

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Treating syphilis: the wetnurse as technology in an eighteenth-century Parisian hospital. Source: Sherwood, J J-Hist-Med-Allied-Sci. 1995 July; 50(3): 315-39 0022-5045

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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CHAPTER 3. ALTERNATIVE MEDICINE AND SYPHILIS Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to syphilis. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to syphilis and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “syphilis” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to syphilis: •

Age at first episode of venereal syphilis in an aboriginal population: an application of survival analysis. Author(s): Mak DB, Holman CD. Source: Aust N Z J Public Health. 1998 October; 22(6): 704-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9848968&dopt=Abstract

•

An introduction to diagnostic criteria of syphilis, treponarid and yaws (treponematoses) in dry bones, and some implications. Author(s): Hackett CJ. Source: Virchows Arch a Pathol Anat Histol. 1975 October 30; 368(3): 229-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=810954&dopt=Abstract

•

Automation of a flocculation test for syphilis on Groupamatic equipment. Author(s): Garretta M, Paris-Hamelin A, Gener J, Muller A, Matte C, Vaisman A.

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Source: Br J Vener Dis. 1975 August; 51(4): 232-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1098731&dopt=Abstract •

Cannibalism and contagion: framing syphilis in counter-reformation Italy. Author(s): Eamon W. Source: Early Science and Medicine. 1998 February; 3(1): 1-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11620327&dopt=Abstract

•

Detection of Treponema pallidum in early syphilis by DNA amplification. Author(s): Wicher K, Noordhoek GT, Abbruscato F, Wicher V. Source: Journal of Clinical Microbiology. 1992 February; 30(2): 497-500. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1537923&dopt=Abstract

•

EDTA-treated plasma in the rapid plasma reagin card test and the toluidine red unheated serum test for serodiagnosis of syphilis. Author(s): Larsen SA, Pettit DE, Perryman MW, Hambie EA, Mullally R, Whittington W. Source: Journal of Clinical Microbiology. 1983 February; 17(2): 341-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6833483&dopt=Abstract

•

From mercury to malaria to penicillin: the history of the treatment of syphilis at the Mayo Clinic--1916-1955. Author(s): Sartin JS, Perry HO. Source: Journal of the American Academy of Dermatology. 1995 February; 32(2 Pt 1): 255-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7829712&dopt=Abstract

•

Immune stimulation by syphilis and malaria in HIV-2-infected and uninfected villagers in West Africa. Author(s): N'Gom PT, Jaffar S, Ricard D, Wilkins A, Ariyoshi K, Morgan G, Da Silva AP, Whittle HC. Source: British Journal of Biomedical Science. 1997 December; 54(4): 251-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9624734&dopt=Abstract

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Prevalence of syphilis and hepatitis B among homosexual men in two saunas in Amsterdam. Author(s): Bleeker A, Coutinho RA, Bakker-Kok J, Tio D, de Koning GA. Source: Br J Vener Dis. 1981 June; 57(3): 196-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7237084&dopt=Abstract

•

Rabbit syphilis diagnosed clinically in household rabbits. Author(s): Saito K, Tagawa M, Hasegawa A.

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Source: The Journal of Veterinary Medical Science / the Japanese Society of Veterinary Science. 2003 May; 65(5): 637-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12808219&dopt=Abstract •

Screening for gonorrhea and syphilis in gay bathhouses in Denver and Los Angeles. Author(s): Merino HI, Judson FN, Bennett D, Schaffnit TR. Source: Public Health Reports (Washington, D.C. : 1974). 1979 July-August; 94(4): 376-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=472098&dopt=Abstract

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Screening for syphilis among homosexual men in bars and saunas in Amsterdam. Author(s): Lumey LH, Kok J, Coutinho RA. Source: Br J Vener Dis. 1982 December; 58(6): 402-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7171983&dopt=Abstract

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Syphilis case-finding in an Australian men's sauna club. Author(s): Bradford DL. Source: The Medical Journal of Australia. 1983 November 26; 2(11): 561-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6415378&dopt=Abstract

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Syphilis during 1900-1910: similarities to present-day AIDS. Author(s): Krause RM. Source: Allergy Proc. 1991 March-April; 12(2): 127-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2060782&dopt=Abstract

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Syphilis referred from complementary medicine therapy. Author(s): Davies S, O'Farrell N. Source: International Journal of Std & Aids. 2003 September; 14(9): 640-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14511505&dopt=Abstract

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Toluidine red unheated serum test, a nontreponemal test for syphilis. Author(s): Pettit DE, Larsen SA, Harbec PS, Feeley JC, Parham CE, Cruce DD, Hambie EA, Perryman MW. Source: Journal of Clinical Microbiology. 1983 November; 18(5): 1141-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6417160&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to syphilis; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview HIV and AIDS Source: Integrative Medicine Communications; www.drkoop.com Lupus Source: Integrative Medicine Communications; www.drkoop.com Proctitis Source: Integrative Medicine Communications; www.drkoop.com Rectal Inflammation Source: Integrative Medicine Communications; www.drkoop.com Sexually Transmitted Diseases Source: Integrative Medicine Communications; www.drkoop.com STDs Source: Integrative Medicine Communications; www.drkoop.com Systemic Lupus Erythematosus Source: Integrative Medicine Communications; www.drkoop.com Urethral Inflammation Source: Integrative Medicine Communications; www.drkoop.com Urethritis Source: Integrative Medicine Communications; www.drkoop.com

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Uveitis Source: Integrative Medicine Communications; www.drkoop.com •

Chinese Medicine Fuling Alternative names: Indian Bread; Poria Source: Chinese Materia Medica Qingfen Alternative names: Calomel; Calomelas Source: Chinese Materia Medica Tufuling Alternative names: Glabrous Greenbrier Rhizome; Rhizoma Smilacis Glabrae Source: Chinese Materia Medica

•

Herbs and Supplements Echinacea Alternative names: Echinacea purpurea, Echinacea angustifolia, Echinacea pallida Source: Healthnotes, Inc.; www.healthnotes.com Echinacea Alternative names: Echinacea angustifolia, Echinacea pallida, Echinacea purpurea, Purple Coneflower Source: Integrative Medicine Communications; www.drkoop.com Echinacea Angustifolia Source: Integrative Medicine Communications; www.drkoop.com Echinacea Pallida Source: Integrative Medicine Communications; www.drkoop.com Echinacea Purpurea Source: Integrative Medicine Communications; www.drkoop.com Myrrh Alternative names: Commiphora molmol Source: Healthnotes, Inc.; www.healthnotes.com Plantain Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Purple Coneflower Source: Integrative Medicine Communications; www.drkoop.com

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Yellow Dock Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON SYPHILIS Overview In this chapter, we will give you a bibliography on recent dissertations relating to syphilis. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “syphilis” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on syphilis, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Syphilis ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to syphilis. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

A Victory in Persuasion: a Descriptive Analysis of the Radio Campaign Conducted by Columbia University, in Association with the United States Public Health Service, for the Nationwide Syphilis Case-finding Drives of 1948-1951 by Guli, Nancy Marion, EDD from Columbia University, 1968, 459 pages http://wwwlib.umi.com/dissertations/fullcit/6906376

•

Effectiveness of Gonorrhea and Syphilis Education in Selected Los Angeles Area Secondary Schools. by Alkhateeb, Waleed Ahmed, DrPH from University of California, Los Angeles, 1976, 142 pages http://wwwlib.umi.com/dissertations/fullcit/7625173

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Guidelines for Teaching College Students about Sexually Transmitted Diseases Other Than Syphilis and Gonorrhea. by Whitmore, Robert Hoover, EDD from Columbia University Teachers College, 1978, 245 pages http://wwwlib.umi.com/dissertations/fullcit/7810905

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Hiv/aids and Five Other Leading Sexually Transmitted Diseases: Knowledge and Behavior Levels of University Freshmen (immune Deficiency, Gonorrhea, Syphilis, Herpes, Genital Warts, Chlamydia) by Roper, Robyn Lynn, EDD from Auburn University, 1994, 117 pages http://wwwlib.umi.com/dissertations/fullcit/9503405

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Syphilis and Civilization: a Social and Cultural History of Sexually Transmitted Disease in Colonial Zambia and Zimbabwe, 1890--1960 by Callahan, Bryan Thomas; PhD from The Johns Hopkins University, 2002, 310 pages http://wwwlib.umi.com/dissertations/fullcit/3046428

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Syphilis, Sexuality, and Social Control: a History of Venereal Disease in Colonial Uganda by Tuck, Michael William, PhD from Northwestern University, 1997, 360 pages http://wwwlib.umi.com/dissertations/fullcit/9814330

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The Impact of an Educational Intervention upon the Attitudes of Selected Black College Students towards Participation in Research Using the United States Public Health Service Syphilis Study at Tuskegee As an Educational Tool by Yeboah, Michelle Adjoa; Drph from Morgan State University, 2003, 172 pages http://wwwlib.umi.com/dissertations/fullcit/3090083

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Treponema Pallidum Repeat Protein K and Heterologous Protection against Syphilis by Morgan, Cecilia Ann; PhD from University of Washington, 2002, 113 pages http://wwwlib.umi.com/dissertations/fullcit/3072120

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Whisper Out Loud! 'Spirochete', a Living Newspaper, 1937-1939, Produced by the Federal Theatre Project, an Instrument for Public Health Education in the War on Syphilis (Washington D.C.) by Gysel, Libra Jan Cleveland, EDD from Virginia Polytechnic Institute and State University, 1989, 372 pages http://wwwlib.umi.com/dissertations/fullcit/9008035

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Witnessing Disease: Autopathographies of AIDS and Syphilis in 16th and 20th Century Germany (Sixteenth Century, Twentieth Century, Immune Deficiency) by Hahn, Rahel L. C., PhD from Cornell University, 1992, 195 pages http://wwwlib.umi.com/dissertations/fullcit/9300787

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. CLINICAL TRIALS AND SYPHILIS Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning syphilis.

Recent Trials on Syphilis The following is a list of recent trials dedicated to syphilis.8 Further information on a trial is available at the Web site indicated. •

Azithromycin/Bicillin for treatment of early syphilis Condition(s): Syphilis Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: The purpose of this study is to determine if azithromycin (2.0 grams administered orally as a single dose), a drug approved for treatment of other infections, is as effective for syphilis therapy as the usual penicillin treatment (Benzathine G penicillin- 2.4 million units). This study is considered research because azithromycin is not licensed for the treatment of syphilis. In addition, in a substudy population of subjects allergic to penicillin, the efficacy of azithromycin will be compared with the currently recommended alternative treatment, doxycycline (100 mg twice daily for 14 days). Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00031499

8

These are listed at www.ClinicalTrials.gov.

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Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “syphilis” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 6. PATENTS ON SYPHILIS Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “syphilis” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on syphilis, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Syphilis By performing a patent search focusing on syphilis, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We

9Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on syphilis: •

Antigen membranes for use in syphilis diagnosis and syphilis diagnosis apparatus using such membranes Inventor(s): Aizawa; Masuo (Tokyo, JA), Ishigur; Isao (Kasugai, JA), Nagamura; Yoichi (Toyoake, JA), Shinohara; Rikio (Kagamihara, JA), Suzuki; Shuichi (Tokyo, JA) Assignee(s): Nippon Chemiphar Co., Ltd. (Tokyo, JA) Patent Number: 4,081,334 Date filed: March 18, 1977 Abstract: An antigen membrane for syphilis diagnosis comprises cardiolipin immobilized in a polymer maxtrix. The membranes are used in syphilis diagnosis and in an apparatus for syphilis diagnosis. Excerpt(s): This invention relates to an antigen membrane for syphilis diagnosis, and a method and apparatus for syphilis diagnosis. Recently, with rapid progress in the field of immunology, important applications of immunology, have been developed, in particular, the introduction of immunochemical methods into clinical analysis, where their usefulness has been confirmed. In most immunoassays, the superior specificity of antigen-antibody reactions is utilized, and a trace amount of a specific substance can be selectively detected. Syphilis diagnosis is a typical example of the application of such immuno-chemical clinical analyses. However, in the conventional syphilis diagnosis method, completion of the antigen-antibody complex forming reaction is observed with the naked eye. Accordingly, the excellent selectivity and sensitivity of the immunochemical specificity are not sufficiently utilized in the final diagnosis step. Web site: http://www.delphion.com/details?pn=US04081334__

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Assaying anti-TP IgM antibodies for syphilis diagnosis Inventor(s): Kayashima; Takako (Tokyo, JP), Kubo; Emiko (Tokyo, JP), Sato; Takashi (Saitama, JP) Assignee(s): Fujirebio Kabushiki Kaisha (Tokyo, JP) Patent Number: 4,716,108 Date filed: February 24, 1986 Abstract: A method of measuring an infectious disease antibody such as syphilis IgM, which comprises treating immunoglobulins of a sample with an anti immunoglobulin antibody sensitized on carrier particles and an antigen of the infectious disease sensitized on carrier particles. According to the method of the invention, the specific antibody of the specific infectious disease such as syphilis IgM can easily and exactly be measured. This method is useful for the judging the stage of infectious disease and watching the results of treatment. Excerpt(s): This invention relates to a method of measuring an infectious disease antibody such as a syphilis antibody, and more particularly, this invention relates to a method of measuring the individual immunoglobulins such as IgM, IgG and IgA, of a particular infectious disease. For instance, with regard to diagnosing methods of syphilis, there are the STS (Serologic Test for Syphilis) method of using cardiolipin

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which is a lipoidal antigen and the method of using Treponema pallidum (hereinafter referred to as TP) as an antigen. The STS method including the VDRL method, the RPR (Rapid Plasma Reagin Card Test) method, the agglutination method, Ogata's method, and Kolmer's method, occasionally produce a biological false positive result due to the antigen which is not TP. Web site: http://www.delphion.com/details?pn=US04716108__ •

Borrelia burgdorferi antigens and uses thereof Inventor(s): Hunt; Jeffrey C. (Lindenhurst, IL), Pilot-Matias; Tami J. (Libertyville, IL), Robinson; John M. (Gurnee, IL) Assignee(s): Abbott Laboratories (Abbott Park, IL) Patent Number: 5,643,733 Date filed: July 10, 1995 Abstract: This invention relates generally to an assay for Lyme disease which detects the antibody to Borrelia burgdorferi, the causative agent of Lyme disease. More specifically, the assay employs antigens derived from amino acid regions in the flagellum of Borrelia burgdorferi. These antigens are immunoreactive with antibodies to Borrelia burgdorferi but are not substantially immunoreactive with antibodies to Treponema pallidum, the syphilis causing agent. DNA sequences of the antigens, clones and vectors containing the DNA sequences are also disclosed. Polypeptides derived therefrom can be used as reagents for the detection of antibody to Borrelia burgdorferi in the body fluids from individuals with Lyme disease. Excerpt(s): Lyme disease is a multisystem illness caused by the tick-transmitted spirochete Borrelia burgdorferi (hereinafter referred to as "B. burgdorferi") (Burgdorfer, et al. 1982. Science 216:1317-1319; Steere, et al. 1983. N Engl J Med 308:733-740). Lyme borreliosis is the most common arthropod-borne infection in the United States and has been reported in many countries throughout Asia and Europe (Steere 1989. N Engl J Med 1:586-596). The early feature of the disease is a local infection of the skin, which may be followed by the development of systemic disease involving the nervous system, heart and joints (Steere 1989. N Engl J Med 1:586-596). Culture of the spirochete from human body fluids and antigen detection methods often are falsely negative in the diagnosis of Lyme disease (Steere, et al. 1983. N Engl J Med 308:733-740; Benach, et al. 1983 N Engl J Med 308:740-742), leaving serological methods for antibodies to B. burgdorferi as the most appropriate currently available means for diagnosis. Most current diagnostic assays for Lyme disease utilize whole or sonicated B. burgdorferi cells as the test antigen, although many investigators have demonstrated improved performance of these tests when subcellular fractions of the spirochete were used (Grodzicki, et al. 1988. J Infect Dis 157:790-797; Magnareli, et al. 1989. J Infect Dis 159:4349; Karlsson, et al. 1990. Eur J Clin Microbiol Infect Dis 9:169-177). The flagellar protein is an immunodominant protein that generally elicits the earliest immune response after infection (Craft, et al. 1986. Clin Invest 78:934-939; Dattwyler, et al. 1989. Rev Infect Dis 11:1494-1498). Flagellin-enriched fractions of B. burgdorferi have been shown to improve the performance of Lyme diagnostic assays (Hansen, et al. 1988. J Clin Microbiol 26:338-346). The specificity of these assays, however, may be reduced because of cross-reactivity of B. burgdorferi flagellum with the flagella of other spirochetes, most notably with Treponema pallidum (hereinafter referred to as "T. pallidum"), the causative agent of syphilis (Magnarelli, et al. 1987. J Infect Dis 156:183-188). Current Lyme disease immunoassays utilize solubilized B. burgdorferi as the source of antigen,

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leading to false positive reactions from individuals with certain conditions, including syphilis, leptospirosis and other spirochetal infections. The lack of specificity is due to the fact that these organisms express similar antigens, especially the highly conserved flagellin protein. Thus, most Lyme disease immunoassays suffer from false positive reactions when syphilis positive patients are analyzed. Many institutions determine syphilis serologic status on all Lyme positive patients; if they are positive for syphilis they are considered to be negative for Lyme disease. This cross-reactivity with syphilis patients can be reduced by adsorption of the patient sera with the Reiter strain of Treponema (Magnarelli, et al. 1990. J Clin Microbiol 28:1276-1279), but this decreases the sensitivity of Lyme-diagnostic assays. Web site: http://www.delphion.com/details?pn=US05643733__ •

Class I-type lysyl-TRNA synthetase Inventor(s): Ibba; Michael (Copenhagen, DK), Soll; Dieter (Hamden, CT) Assignee(s): Yale University (New Haven, CT) Patent Number: 6,492,131 Date filed: March 10, 2000 Abstract: A protein with canonical lysyl-tRNA synthetase activity was purified from Methanococcus maripaludis, cloned, and sequenced. The predicted amino acid sequence of the enzyme indicated a novel class I polypeptide structurally unrelated to class II lysyl-tRNA synthetase reported in eubacteria, eukaryotes, and the Crenarchaeote Sulfobus solfataricus. A similar class I polypeptide was isolated from Borrelia burgdorferi, the causative agent of Lyme disease, and an open reading frame encoding a class I-type lysyl-tRNA synthetase was identified in the genome of Treponema pallidum, the causative agent of syphilis. The B. burdorferi gene encoding tRNALysl was cloned and used to make tRNA in vitro. The fundamental difference between pathogen and host in an essential enzyme suggests that class I-type lysyl-tRNA synthetase provides a target for the development of medical and veterinary therapeutics and diagnostics for Borrelia and other microorganism infections. Excerpt(s): This invention relates to a new class I-type lysyl-tRNA synthetase isolated from archaebacteria and Borrelia. Lysyl-tRNA synthetase (LysRS) is essential for the translation of lysine codons during protein synthesis. In spite of the necessity for this enzyme in all organisms and the high degree of conservation among aminoacyl-tRNA synthetases (1), genes encoding a LysRS homologue have not been found by sequence similarity searches in the genomes of two Archaea, Methanococcus jannaschii (2) and Methanobacterium thermoautotrophicum (3). This raises the possibility that. LysRS, like the asparaginyl- and glutaminyl-tRNA synthetases (4), is not present, with lysyl-tRNA (Lys-tRNA) synthesized by tRNA-dependent transformation of a misacylated tRNA (5). Alternatively, these organisms may contain a LysRS activity encoded by a gene sufficiently different to those previously identified to prevent its detection by sequence similarity searches. This invention confirms the latter hypothesis and provides isolated and purified class I-type lysyl-tRNA synthetase (hereafter sometimes denoted herein as LysRSI) and active fragments and variants thereof, DNA and RNA sequences encoding class I-type lysyl-tRNA synthetase (and biological equivalents and fragments thereof), and methods for screening for class I-type lysyl-tRNA synthetase inhibitors for medical and veterinary use. It further provides methods for screening for infection of an organism by microorganisms expressing class I-type lysyl-tRNA synthetase.

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Web site: http://www.delphion.com/details?pn=US06492131__ •

Combination needle shield/needle guard device positively locked onto detachable needle assemblies for an evacuated blood collection system and a hypodermic syringe Inventor(s): Sagstetter; William E. (Denver, CO), Wanderer; Alan A. (Englewood, CO) Assignee(s): Medical Safety Products, Inc. (Denver, CO) Patent Number: 4,731,059 Date filed: October 14, 1986 Abstract: This invention relates to a combination needle shield/needle guard device that is positively locked onto detachable needle assemblies for an evacuated blood collection system and for a hypodermic syringe. More particularly, this invention can: (1) function as a needle shield to enclose and prevent contamination of the sterile needle to be used for a medical procedure; (2) function as a needle guard which can slide on a length extension for either needle assembly, such that the needle can be uncovered or recovered in a direction from behind the needle point, thereby providing a safety feature for the operator who can avoid direct contact with a used, blood-contaminated needle point. Avoidance of direct contact with used needle points will reduce the likelihood of contracting blood-borne infections such as AIDS, infectious hepatitis, syphilis etc. that might occur following accidental puncture with contaminated needles; (3) provide improved securing for an evacuated blood collection system between the double-ended needle assembly and the container holder, thereby preventing the double-ended needle assembly from unlocking with the container holder during the process of withdrawing blood into an evacuated container and (4) improve blood withdrawing success with the blood evacuated collection system and with a large volume syringe. This occurs by the addition of a length extension which separates the wide girth of the container holder or the wide girth of a large volume syringe barrel from close approximation to the needle used for withdrawing blood, thereby permitting more shallow or acute angle access of needle entry into a blood vessel during blood withdrawing procedures. Excerpt(s): This invention relates to a combination needle shield/needle guard device which is positively locked onto a (1) detachable double-ended needle assembly used for an evacuated blood collection system and (2) a detachable needle assembly for a hypodermic syringe. More particularly, this combination needle shield/needle guard device can function as a needle shield to enclose and prevent contamination of a sterile needle to be used for insertion into the skin and/or blood vessel of a patient. In addition, the needle shield/needle guard device can function as a needle guard which can slide on the needle assemblies, so that the needle can be uncovered or re-covered in a direction from behind the needle point, thereby providing a safety feature for the operator who can avoid direct contact with a used, blood-contaminated needle point. There are many types of removeable needle shields which cover needles used with conventional syringes or are used to cover a double-ended needle assembly with an evacuated blood collection system. Examples include the following references selected from the U.S. Patent and Trademark Office: U.S. Pat. Nos. 3,381,813; 3,934,722; 4,113,090; 4,121,588; 3,734,080; and 3,931,815. These removeable needle shields reveal several limitations such as: (1) after removal of the needle shield from the needle attached to a syringe, medical personnel may occasionally delay the usage of the needle in a procedure, which would require replacement of the needle shield back over the needle to prevent contamination of the sterile needle. This maneuver requires keeping track of the removed needle shield and then replacing the needle shield over the needle, which

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represent extra steps for busy medical personnel. Replacing the needle shield over the needle point also increases the risk for self-puncture with the needle point; (2) another common practice occurs when medical personnel remove this type of needle shield by holding the needle shield between their teeth or lips. This maneuver has been associated with accidental self-puncture in the face or other bodily parts; (3) in order to remove a used double-ended needle assembly from a reuseable container holder of an evacuated blood collection system, it is necessary to re-cover the used needle with a needle shield and then unfasten the double-ended needle assembly from the reusable container holder. Similarly, to remove a used needle that is luer-locked to a syringe barrel, it is necessary to re-cover the needle with a needle shield and then unfasten the needle from the syringe barrel. Both procedures require that the user replace the needle shield over the pointed end of the used needle, which increases the risk to medical personnel who may accidentally puncture themselves with the pointed end of the used, blood contaminated needle; (4) when the needle shield is replaced over the used needle, if the needle has been accidentally bent during a medical procedure or if the needle shield is replaced over the needle at an incorrect angle, the needle point may inadvertently pierce the side of the needle shield as it is being replaced over the needle. The operator using the needle shield could be punctured with a used blood-contaminated needle point that has exteriorized through a needle shield; and (5) most laboratories use containers with or without a clip-off needle device to store used needles. Personnel may puncture themselves with used uncovered needles that may accidentally fall out of these storage containers or with uncovered needles that are disposed of inappropriately in waste baskets. In addition, if the storage container is full, it is possible to accidentally puncture oneself with a used, uncovered needle that is pointed towards the opening of the storage container. Another device relevant to our invention includes U.S. Pat. No. 4,425,120 issued to Sampson et al which describes a needle guard device which is attached to a conventional hypodermic syringe or apparatus used for injecting a substance into a human or animal. This device functions as a slideable needle guard to uncover or recover a used needle. This needle guard has an open-end, which precludes its routine use to function also as a needle shield to enclose and prevent contamination of a sterile needle. In order to prevent contamination of the sterile needle in this device, it would be necessary to cover the needle with a separate needle shield, or close the opening of the needle guard with a material which must be ruptured by the needle or needle shield enclosing the needle. In addition, this needle guard device is not adapted to remove a used double-ended needle assembly from a container holder or to remove a used hypodermic syringe needle assembly from a syringe barrel. Thus, in both situations a separate needle shield would still be required to re-cover and unfasten the detachable needle assemblies, thereby increasing the risk for self-puncture with a used needle point. Web site: http://www.delphion.com/details?pn=US04731059__ •

DNA polymerase from Treponema pallidum Inventor(s): Steiner; Bret Martin (Atlanta, GA) Assignee(s): United States of Ameria (Washington, DC) Patent Number: 6,020,128 Date filed: June 10, 1997 Abstract: The nucleic acid sequence encoding the gene for the DNA polymerase I enzyme of Treponema pallidum, the organism causing syphilis. Nucleic acid molecules

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useful as probes for detecting Treponema pallidum are described. Isolated, recombinant, and synthetic DNA polymerase I enzyme of Treponema pallidum, and the amino acid sequence of the enzyme, are also described. Antibodies to DNA polymerase I from Treponema pallidum are further provided. The nucleic acid molecules are useful in methods for the detection and diagnosis of Treponema pallidum infection in a sample or subject. Excerpt(s): The present invention relates in general to the fields of enzymology and diagnostic microbiology. In particular, the invention relates to a novel DNA polymerase gene, its sequence and product, and the detection of syphilis using DNA probes and primers therefrom. Syphilis is an infectious venereal disease caused by the spirochete, Treponema pallidum. Syphilis is usually transmitted by sexual intercourse or acquired congenitally. If left untreated, the disease can ultimately lead to the degeneration of bones, heart, nerve tissue and other organs or tissues. Little is known about the molecular biology of Treponema pallidum and less about the mechanisms of DNA synthesis and repair in this spirochete. The T. pallidum organism has an extremely long generation time (generally estimated at around 30 hours), but the limitations on its growth rate are unknown (1). It was hypothesized some 20 years ago from fragmentary data on the rate of DNA synthesis in a suboptimal in vitro culture system, that DNA synthesis is very slow in T. pallidum (2). DNA repair in T. pallidum appears to be defective with regard to oxidative lesions (3), but little else is known. This is unfortunate, since defects in DNA repair may relate to the fact that this treponeme cannot be grown in a cell free system, or be maintained at present even in the presence of tissue culture cells (4). Therefore, the isolation of the gene for DNA polymerase I from T. pallidum could be very important in answering questions about DNA replication and repair since it is important in both of these essential functions. Web site: http://www.delphion.com/details?pn=US06020128__ •

Enzyme/immunofluorescent assay for anti-treponemal antibodies Inventor(s): Binder; Walter L. (San Diego, CA), Coates; Stephen R. (Lafayette, CA) Assignee(s): American Hoechst Corporation (Somerville, NJ) Patent Number: 4,645,737 Date filed: March 5, 1984 Abstract: A method for the determination of anti-treponemal antibody in a test sample comprises contacting a substrate for the anti-treponemal antibody with sample; treating the contacted substrate with labeled antihuman Ig antibody selected from (a) a mixture comprising enzyme labeled antihuman Ig antibody and fluorescent labeled antihuman Ig antibody, (b) antihuman Ig antibody labeled with an enzyme and a fluorescent label, and (c) fluorescent labeled antihuman Ig antibody to which enzyme labeled antibody against the animal species from which the antibody used in the fluorescent labeled antibody was derived is added subsequently, and (d) enzyme labeled antihuman Ig antibody to which fluorescent labeled antibody against the animal species from which the antibody used in the enzyme labeled antibody was derived is subsequently added; determining the enzyme activity of the treated substrate; and determining the immunofluorescent patterns in substrates exhibiting enzyme activity. The method is useful for the rapid screening of anti-treponemal antibodies for the diagnosis of syphilis.

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Excerpt(s): Immunofluorescence is routinely employed in testing human serum for the presence of anti-treponemal antibodies associated with syphilis. The immunofluorescent antibody technique consists of two antigen--antibody reactions. The first reaction takes place between anti-treponemal antibody contained in the serum sample and specific antigen localized in a particular substrate. The second reaction is between the anti-treponemal antibody/antigen complex and antihuman immunoglobin (Ig) antibody that has been tagged with a fluorescent label. After the second reaction, the substrate is examined for fluorescence using the fluorescent microscope. In positive samples, the patterns of fluorescence are used as indicators for additional tests. In spite of its accuracy and ease of use, the immunofluorescent antibody technique has one major disadvantage. It does not allow for quick screening of a number of serum samples since each sample must be individually studied under a fluorescent microscope to ascertain whether the serum is positive or negative. Since the majority of sera routinely tested are negative for anti-treponemal antibody, the advantages of a method which would eliminate microscopic examination of negative sera are obvious. Such a method would be less labor intensive and therefore less expensive. It is an object of the present invention to provide a fast and accurate method of screening a large number of serum samples for anti-treponemal antibody, which, when present, can be further confirmed by fluorescent microscopy. Web site: http://www.delphion.com/details?pn=US04645737__ •

Fibrin adhesive prepared as a concentrate from single donor fresh frozen plasma Inventor(s): Dresdale; Arthur (Plainfield, NJ), Rose; Eric (Palisades, NY) Assignee(s): The Trustees of Columbia University in the City of New York (New York, NY) Patent Number: 4,627,879 Date filed: January 3, 1985 Abstract: This invention concerns a method of preparing a cryoprecipitated suspension containing fibrinogen and Factor XIII useful as a precursor in the preparation of a fibrin glue which involves (a) freezing fresh frozen plasma from a single donor such as a human or other animal, e.g. a cow, sheep or pig, which has been screened for blood transmitted diseases, e.g. one or more of syphilis, hepatitis or acquired immune deficiency syndrome at about =80.degree. C. for at least about 6 hours, preferably for at least about 12 hours; (b) raising the temperature of the frozen plasma, e.g. to between about 0.degree. C. and room temperature, so as to form a supernatant and a cryoprecipitated suspension containing fibrinogen and Factor XIII; and (c) recovering the cryoprecipitated suspension.The invention also concerns a method of preparing a fibrin glue useful in surgical procedures which comprises: (a) preparing a cryoprecipitated suspension as described above; (b) applying a defined volume of the suspension to a desired site; and (c) applying a composition containing a sufficient amount of thrombin, e.g. human, bovine, ovine or porcine thrombin, to the site so as to cause the fibrinogen in the suspension to be converted to the fibrin glue which then solidifies in the form of a gel.The thrombin-containing composition may also contain a suitable amount of an anti-fibrinolytic substance, e.g. aprotinin and a suitable amount of CaCl.sub.2.The invention also concerns the cryoprecipitated suspension, the fibrin glue formed therefrom, fibrin glue kits and a method for sealing surgical wounds. Excerpt(s): Within this application several publications are referenced by arabic numerals within parentheses. Full citations for these references may be found at the end

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of the specification immediately preceding the claims. The disclosures of these publications in their entireties are hereby incorporated by reference into this application. Various techniques have been described to pretreat porous vascular prostheses. Many are complicated, time consuming, expensive procedures and often render prostheses stiff and non-yielding (7,18). A previously described highly effective method using a cryoprecipitate preparation (6) was criticized because of its high cost (11). Haverich et al. (8) reported that fibrin presealing allows the use of high porosity knitted Dacron prostheses even in heparinized patients. A highly porous fabric, with its superior healing characteristics, offers the potential for a lower incidence of right ventricular conduit obstruction (8). Fibrin presealed grafts are no more thrombogenic, and may be less so, than untreated grafts or those pretreated with blood (9,18). Highly porous fabrics have superior handling characteristics compared to low porosity grafts, and the use of fibrin adhesive could make low porosity woven Dacron grafts obsolete. Web site: http://www.delphion.com/details?pn=US04627879__ •

Immunodiagnostic test for syphilis and other treponemal infections Inventor(s): Alderete; John F. (San Antonio, TX), Baseman; Joel B. (San Antonio, TX) Assignee(s): Board of Regents, The University of Texas System (Austin, TX) Patent Number: 4,894,328 Date filed: May 4, 1987 Abstract: A component for the rapid detection of anti-Treponema pallidum antibodies adapted for use as a selective foundation material in standard immunoassays is provided. The component comprises a quantity of fibronectin insolubilized to a solid matrix. The fibronectin component provides a foundation material for the selective binding of antigenic outer membrane proteins extracted from Treponema pallidum. Incorporation of the insolubilized fibronectin component bound to the antigenic outer membrane proteins extracted from Treponema pallidum into a standard immunoassay test pack provides an immunological assay for the presence of respective complementary anti-Treponema pallidum antibody in a biological sample. Excerpt(s): The present invention relates to immunological diagnostic assays; and more particularly it relates to immunological diagnostic tests for syphilis and related treponemal infections. Syphilis is a unique disease associated with a complex host response which may be accompanied by intermittent periods of latency and classical stage development. Neither protective immunogens nor mechanisms of host resistance have been clearly defined. Also, little information is available concerning the biologicalchemical properties of T. pallidum that relate to virulence. The limitations of the model system, including the inability to sequentially in vitro passage virulent treponemes, represent serious experimental deficiencies in developing potential diagnostic assays and vaccinogens. Currently available immunodiagnosis assays for syphilis are inadequate. Routinely, a "non-specific" screening test (VDRL, cardiolipin antigen) is used which causes many false-positive reactions. For example, numerous infections and autoimmune disorders as well as syphilis cause increases in the detected anticardiolipin antibodies. Also, this test fails to identify significant numbers of syphilispositive test samples. Furthermore, the antigen-specific test for confirmation of syphilis is most often the FTA-ABS slide test which requires whole organisms, fluoresceinconjugated reagents and fluorescence microscopy, which involves a timeconsuming, expensive and qualitative assay. Therefore millions of serodiagnostic tests are performed each year in the U.S. alone under clearly suboptimal assay conditions

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resulting in a tremendous economic and emotional burden in our population. In addition, immuno-diagnosis of pinta and yaws (other human treponemal diseases) is unsatisfactory. The present invention should markedly assist in improved diagnosis of these treponemal infections. The Applicants have evolved a strategy that permits identification and characterization of T. pallidum virulence determinants which are believed to be present in syphilis and these other pathogenic spirochetes. As an outcome of this strategy, Applicants have devised a rational and experimentally effective method for serodiagnosis of syphilis and related treponemal infections that can be used routinely with greatly improve specificity. Web site: http://www.delphion.com/details?pn=US04894328__ •

Intrauterine contraceptive devices and processes Inventor(s): Gutnick; Morton (8329 Fairview Road, Elkins Park, PA 19117) Assignee(s): none reported Patent Number: 3,996,933 Date filed: October 14, 1975 Abstract: An intrauterine contraceptive device comprising an elongated shank having divergent convoluted portions at its distal end, said convoluted portions being generally sinusoidal in nature, said device having incorporated in said shank a permanent magnet and having a substantial portion of its surface covered with a biologically inert, silicone elastomeric material which may contain an analgaesic or anti-fertility agent which is gradually eleased in utero. In a preferred embodiment of the invention, the proximal end, of the shank contains a pair of downwardly extending divergent, resilient legs which tend to prevent inadvertent expulsion of the device. In another preferred embodiment, the lower end of the device is also formed with one or more small refillable containers for certain types of medication which are released gradually into the vagina and the lower end of the uterus over a prolonged period of time for the prevention and cure of such venereal diseases as gonorrhea, syphilis, trichomonas vaginalis and moniliasis. Excerpt(s): The invention relates to both new and useful improvements in contraceptive devices for human beings and other animals which serve also to prevent and cure venereal and other diseases. It has been known for many years that a foreign object in the uterus will prevent conception. To date, many different types of intrauterine contraceptive devices, also known as IUDs, have been proposed, and several types are in widespread use, but none have been fully satisfactory. Bleeding and pain account for eighty-five per cent of the complications or side effects of intrauterine contraceptive devices. Therefore, any device that would reduce or eliminate bleeding and pain would lead to fewer removals of intrauterine contraceptive devices for "cause," and would allow a greater percentage of patients to "continue to use" the IUDs and would probably also expand the usage of IUDs. Web site: http://www.delphion.com/details?pn=US03996933__

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Methods for diagnosing syphilis Inventor(s): Kettman; John R. (Carrollton, TX), Norgard; Michael V. (Plano, TX) Assignee(s): Board of Regents, The University of Texas (Austin, TX) Patent Number: 4,740,467 Date filed: February 15, 1985 Abstract: Murine anti-Treponema pallidum monoclonal antibodies were employed in the detection of low numbers of pathogenic treponemes. Monoclonal antibodies were used as a primary antibody source in a solid-phase immunoblot assay system. All monoclonal antibodies assayed were capable of detecting ca. 1.0.times.10.sup.3 to 2.5.times.10.sup.3 treponemes. Of 13 monoclonal antibodies examined, 3 were able to detect 10.sup.3 virulent treponemes, and 1 of these antibodies was able to reveal the presence of as few as 500 organisms. Western blot analyses showed that all anti-T. pallidum monoclonal antibodies exhibiting high sensitivities for the detection of T. pallidum cells were directed against an abundant, 47,000-48,000 dalton surface-exposed antigen of the organism. With two possible exceptions, the monoclonal antibodies tested reacted specifically with T. pallidum, either purified or found within a highcontaminating tissue background, and not with Treponema phagedenis biotype Reiter, Haemophilus ducreyi, Neisseria gonorrhoeae, herpes simplex virus type 2, or normal rabbit testicular tissue. Excerpt(s): The present invention relates to methods of diagnosing syphilis and, in particular, to methods of diagnosing syphilis using monoclonal antibodies specific for Treponema bacterial pathogens. Untreated syphilis in man is a severe, chronic, and very complex disease that can often be extremely difficult to diagnose. Limitations with current diagnostic tools and the absence of a vaccine have allowed syphilis to flourish at the estimated frequency of approximately 350,000 cases per year in the United States alone, even with the availability of effective penicillin treatment. At present, in the diagnosis of early syphilis, dark-field microscopy is used to identify Treponema pallidum in lesion exudates. This method is based upon the observance of characteristic spirochetal morphology and motility. The clinical diversity of early syphilitic lesions, their similarity to those which may occur among patients with other genital ulcer diseases, and the lack or inconclusive nature of serological reactivity which may be present during the primary stage of infection point to the significance assigned to this technique in diagnosis. Further, the results of dark-field microscopy in these circumstances determine the need for treatment and epidemiological follow-up. It is unfortunate that this procedure is fraught with severe biological and technical restrictions which may result in diagnostic errors, inappropriate therapy, misdirection of epidemiological investigation, and the placement of unnecessary stigma upon the patient. Web site: http://www.delphion.com/details?pn=US04740467__

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Nucleotide sequences of T. pallidum rare outer membrane protein Inventor(s): Blanco; David R. (Beverly Hills, CA), Champion; Cheryl I. (Culver City, CA), Lovett; Michael A. (Los Angeles, CA), Miller; James N. (Northridge, CA), Tempst; Paul J. (New York, NY) Assignee(s): Sloan-Kettering Institute for Cancer Research (New York, NY), The Regents of the University of California (Oakland, CA) Patent Number: 5,753,459 Date filed: January 23, 1996 Abstract: Antigenic rare outer membrane proteins of Spirochaetaceae are obtained from organisms extracted from infected tissue by a novel process of isolation utilizing a discontinuous Ficoll gradient separation, release of outer membrane in a low isotonic and low pH buffer and identification of outer membrane by use of a lipid soluble dye. Four antigenic rare outer membrane proteins of T. pallidum subsp. pallidum useful in diagnosis and prophylaxis of syphilis are provided. Also provided are the amino acid sequences of two rare outer membrane proteins of T. pallidum subsp. pallidum, called TROMP 1 and TROMP 2, and the nucleotide sequences encoding them. Excerpt(s): This invention relates to methods for isolation of rare proteins from bacterial samples. More particularly, this invention relates to a method for isolating rare outer membrane proteins from the family Spirochaetaceae, such as genus Treponema and to the use of such proteins in diagnosis and prophylaxis of related diseases. The genus Treponema (order Spirochaetales, family Spirochaetaceae), a type of gram-negative bacteria, contains four human pathogens as well as at least six nonpathogens. The pathogens are characterized by an extreme sensitivity to environmental conditions that renders them impossible to culture in vitro. Due to DNA homology the agents that cause syphilis, yaws and endemic syphilis have been combined into one species and three subspecies: T. pallidum subsp. pallidum (syphilis); T. pallidum subsp. pertenue (yaws); and T. pallidum subsp. endemicum (endemic syphilis). T. carateum, which is the causative agent of pinta, remains a separate species. Syphilis is found worldwide, yaws is endemic in the tropics, pinta is prevalent in tropical areas of Central and South America, and endemic syphilis is restricted to desert regions. These treponemal infections are very complex, each exhibiting distinct stages of symptomatic manifestations followed by asymptomatic periods. Without antibiotic therapy, these diseases are chronic and may last for 30 to 40 years. To date, the four pathogens have been considered antigenically identical. An individual subspecies-specific antigen has not been identified and serological reactions demonstrate immunological relatedness. Both Wassermann and anti-T. pallidum subsp. pallidum antibodies develop in response to each treponemal disease, and known protective immunogens are also related, as shown by cross-resistance (T. B. Turner, et al., Biology of the Treponematoses. W.H.O Monogr. Ser. 35:1-277, 1957). Therefore, the geographical location together with the clinical manifestations of the patient have been considered the key to diagnosis (Manual of Clinical Microbiology, 5th Ed., A. Balows, et al., Eds., p 567, 1991). Web site: http://www.delphion.com/details?pn=US05753459__

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Process for preparing purified syphilis antigen from Treponema palljdum Inventor(s): Ishikawa; Fumio (Takatsuki, JP), Matsumoto; Mie (Moriyama, JP), Nagahara; Kouhei (Kamaishi, JP) Assignee(s): Sekisui Chemical Co., Ltd. (Osaka, JP) Patent Number: 5,474,900 Date filed: July 7, 1994 Abstract: A process for preparing a purified syphilis antigen from Treponema pallidum is presented. The process comprises the steps of obtaining an extract from Treponema pallidum, adsorbing the extract onto hydroxyapatite gel and eluting the antigen in the presence of a surfactant. The preferred surfactant is octylglucopyranoside, A diagnostic agent is prepared which comprises the purified syphilis antigen adsorbed on an inert carrier, which carrier at least partially a hydrophobic carrier to which the antigen is adsorbed. Excerpt(s): The present invention relates to a process for preparing an antigen of Treponema (Treponema pallidum, hereinafter sometimes abbreviated to TP) which is used as a reagent for diagnosing syphilis. More particularly, the present invention relates to a method for preparing an antigen which enables to prepare a diagnostic agent for syphilis, exhibiting high specificity and being able to detect primary syphilis. Further, this invention relates to a diagnostic reagent for syphilis and a method for preparing the same. Diagnostic methods have been performed which utilize the antigenantibody reaction of TP antigens and anti-treponemal antibodies (hereinafter abbreviated to TP antibody) in sera from syphilitic patients. Among such methods, TPHA (Treponema pallidum hemaggultination assay test) has been widely used in recent years because of the advantages in its sensitivity, specificity and convenience in operation. Therefore, the TPHA has been a typical diagnostic method for syphilis. The antigen solution originated from TP and used in the above-mentioned method is prepared as follows: First, TP is inoculated and cultivated in rabbit testes. The treponemes are extracted and suspended in a suitable buffer and then disrupted by homogenizer, sonicator and so forth. Thus disrupted treponemes with or without solubilization was used as the antigen solution for sensitization. Web site: http://www.delphion.com/details?pn=US05474900__

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Radioimmunoassay Inventor(s): Davis; Raymond Vincent (North Caldwell, NJ) Assignee(s): Hoffmann-La Roche Inc. (Nutley, NJ) Patent Number: 4,076,797 Date filed: September 28, 1976 Abstract: A radioimmunoassay for syphilis using Treponema pallidum reiter variant as the antigen in an indirect procedure is disclosed. Excerpt(s): Immunological assays for antibodies to the causative organism of syphilis (Treponema pallidum) in the blood of patients heretofore have been carried out by the Treponema pallidum Hemagglutination test (TPHA), the Fluorescent Treponema Antibody Absorption test (FTA-Abs) and the Trepenoma pallidum Immobilization test (TPI). These assays require a subjective estimate of antibody titer. An accurate assay in which the results are objectively determined is desirable since the results are more

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reproducible and can be realistically compared between different laboratories. In addition, it is desirable to have an assay in which the procedure as well as the final readout are amenable to automation. This invention is based on the discovery that a radioimmunoassay for syphilis can be successfully carried out in the solid phase utilizing as the antigen, Treponema pallidum reiter variant (hereinafter referred to as T. reiteri). The assay gives reproducible, accurate, objective results despite the fact that Treponema reiteri is a non-infectious variant of the causative agent of syphilis, Treponema pallidum. This result occurs, apparently, because the antibodies in the patient's blood are reactive with both T. reiteri and T. pallidum. However, T. pallidum is difficult to isolate in sufficiently pure form in such a manner that its antigenic sites are retained while T. reiteri can be grown in vitro and in small and large volume broth cultures and isolated by centrifugation while retaining its antigenic sites. Web site: http://www.delphion.com/details?pn=US04076797__ •

Reagent and merchandising kit for use in the diagnosis of syphilis and preparation thereof Inventor(s): Kubo; Emiko (Tokyo, JP), Sato; Takashi (Saitama, JP) Assignee(s): Fujizoki Pharmaceutical Co., Ltd. (Tokyo, JP) Patent Number: 4,618,588 Date filed: September 30, 1982 Abstract: A reagent and merchandizing kit for use in the diagnosis of syphilis by hemagglutination of an anitgen obtained from a culture of pathogenic Treponema pallidum Nichols and which is sensitized on carrier particles in the presence of antibody wherein said antigen is substantially devoid of proteinic fractions of said culture having a specific gravity of less than 1.01, and methods of preparing the same. Excerpt(s): This invention relates to an improved reagent for conducting a Treponema pallidum hemagglutination test (TPHA test) for the diagnosis of syphilis, and a process for producing the same. The TPHA test is carried out by using hemagglutination of antigen which is obtained from a culture of pathogenic Treponema pallidum Nichols (hereinafter referred to as TP) and which is sensitized on carrier particles, such as mammalian red blood cells, in the presence of the corresponding antibody. More particularly, this invention relates to improving said antigen sensitized on carrier particles capable of detecting the syphilis at the primary stage (hereinafter referred to as primary syphilis). Prior methods of diagnosing syphilis, included the STS method which was insufficient in specificity. Accordingly, various methods utilizing the antigen-antibody reaction between the antigen of TP cells and the antibody in the blood serum of a patient have been developed. For instance, the FTA test provides for the reaction of the antibody in the serum of a patient with the antigen of TP cells, and the antibody which is the product of the above antigen-antibody reaction is detected by using the anti gamma globulin which is labelled with a fluorescent material. This FTA test is disadvantageous because it is a complicated procedure. Web site: http://www.delphion.com/details?pn=US04618588__

Patents 109

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Reaginic test for syphilis Inventor(s): Yabusaki; Kenichi K. (Albany, CA) Assignee(s): Advanced Polymer Systems, Inc. (Redwood City, CA) Patent Number: 4,738,932 Date filed: December 3, 1985 Abstract: A reaginic agglutination test for syphilis-associated antibodies is disclosed. The test uses an antigen reagent that comprises a buffered aqueous suspension of cardiolipin antigen ionically coupled to latex particles via a polypeptide bridge. Positive sera react with the antigen reagent and yield an agglutination pattern characterized by medium to large aggregates. Negative sera yield no agglutinated particles. Excerpt(s): This invention is in the field of immunological testing. More particularly, it concerns a screening test for syphilis-associated antibodies that employs cardiolipin antigen ionically coupled to latex particles via a polypeptide bridge. Two main categories of serologic tests for syphilis are available: tests for reaginic antibody and tests for treponemal antibody. Reaginic tests use cardiolipin as antigen and are normally used for screening because they are sensitive and fast, but lack a high degree of specificity. The treponemal tests use treponemal antigens and, because they involve a more rigorous and demanding procedure, are used principally as confirmatory tests on samples that are positive in the reaginic test. Commercial reaginic tests are divided into two categories: microscopic and macroscopic. The microscopic tests are the Venereal Disease Research Laboratory (VDRL) slide and the Unheated Serum Reagin (USR) tests. The VDRL antigen consists of an ethanol solution of 0.03% cardiolipin, 0.9% cholesterol, and 0.21% lecithin. VDRL antigen is added to buffered saline containing 0.05% formaldehyde to form a suspension of VDRL antigen. The antigen suspension is then added to heat-treated (56.degree. C. for 30 min) serum. If the serum contains reaginic antibodies, they will combine with the antigen to form a flocculant that is visible on microscopic examination. Lack of flocculation is a negative reaction. The USR is a flocculation test similar to the VDRL. It differs from the VDRL in that is uses a VDRL antigen suspension stabilized with ethylene diamine tetraacetic acid with choline chloride added and does not require serum heating. Web site: http://www.delphion.com/details?pn=US04738932__

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Replication of virulent treponema pallidum in tissue culture Inventor(s): Cox; David L. (East Palo Alto, CA), Fieldsteel; A. Howard (Cupertino, CA), Moeckli; Randolph A. (Mountain View, CA) Assignee(s): SRI International (Menlo Park, CA) Patent Number: 4,464,470 Date filed: January 27, 1982 Abstract: A method and materials are provided for replication of virulent Treponema pallidum in tissue culture, employing a modified Eagle's minimum essential medium, wherein said in vitro cultivated T. pallidum can be utilized as a source of relatively pure organisms, free of host tissue, for the preparation of a vaccine against syphilis and as a source of organisms for use in specific immunological tests for syphilis. Excerpt(s): The development of a vaccine for syphilis has been hindered by inability to culture the causative organism Treponema pallidum in vitro. Reports of successes have

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been published, but when identical procedures were attempted by different investigators, multiplication was not detected. In order to achieve the necessary cultivation, it is essential that a method be reproducible in other laboratories before it can be called successful. Thus, see the following U.S. Pat. Nos. 2,255,079, 2,513,327, 2,709,670, 3,502,546 and 4,098,646. Additionally, see Graves et al, Retention of Motility and Virulence of T. pallidum in vitro; Infection and Immunity. 1975, 12(5) 1116-20 (U.S.A.),--Serzhantova, Growth of T. pallidum, in a Thioglycollate Medium Vestn. Dermatol. 1969, 43(8) 48-51 (Russian),--Boak et al, Studies on the Cultivation of T. pallidum, American Journal of Syphillis, Gonorrhea, Venereal Diseases 33, 409-15 (1942). See also Fitzgerald, The Future of Tissue Culture Methods for Growth of Treponema pallidum in vitro, Sexually Transmitted Diseases April-June, 1980, pp 97-99,--and Musher et al.--The Role of A Vaccine for Syphilis--ibid October-December 1977, pp 163166, Cox, C. D. and M. K. Barber. 1974. Oxygen uptake by Treponema pallidum. Infect. Immun. 10:123-127. Fieldsteel, A. H., F. A. Becker, and J. G. Stout. 1977. Prolonged survival of virulent Treponema pallidum (Nichols strain) in cell-free and tissue culture systems. Infect. Immun. 18:173-182. Fieldsteel, A. H., D. L. Cox, and R. A. Moeckli. 1981. Cultivation of virulent Treponema pallidum in tissue culture. Infect. Immun. 32:905-915. Web site: http://www.delphion.com/details?pn=US04464470__ •

Serological test for syphilis Inventor(s): Stevens; Roy W. (Schenectedy, NY) Assignee(s): Research Corporation (New York, NY) Patent Number: 4,288,426 Date filed: March 20, 1980 Abstract: Serological method of testing for Treponema pallidum antibodies in human serum which is diluted with physiological saline to a dilution of from 1:20 to 1:100 by incubating the diluted serum with a lysate of T. pallidum adsorbed on an inert adsorbent and detecting an antigen-antibody conjugate when antibodies are present. Excerpt(s): This invention relates to serologic methods for determining the presence of antibody to Treponema pallidum (Tp) in human sera. The standard treponemal tests for syphilis in humans presently accepted by the United States Public Health Service are the fluorescent treponemal antibody-absorption (FTA-ABS) test and the microhemagglutination Treponema pallidum (MHA-Tp) test. The FTA-ABS is a manual, indirect FA microscope technique utilizing whole Tp microorganisms which are air dried and acetone fixed on glass slides. A determination of a positive or negative result is made on the basis of the fluorescence observed by the technician. The test is routinely performed in large volume testing laboratories. However, it is avoided in smaller laboratories because in low volume it is not cost effective, and the technicians do not have the experience to make the subjective decisions between positive and negative results accurately. It is, however, the presently acknowledged standard. Web site: http://www.delphion.com/details?pn=US04288426__

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Patent Applications on Syphilis As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to syphilis: •

Compositions and methods for the prevention, treatment and detection of tuberculosis and other diseases Inventor(s): Leishman, Kathryn; (Los Angeles, CA) Correspondence: Heller Ehrman White & Mcauliffe Llp; 1666 K Street,nw; Suite 300; Washington; DC; 20006; US Patent Application Number: 20030108927 Date filed: October 7, 2002 Abstract: Methods and compositions are provided for the prevention and treatment of infectious diseases such as syphilis, tuberculosis, pneumonia, other bacterial infections, AIDS, and other viral infections. Many of the compositions are active against carbon monoxide dehydrogenase ("CODH"), and include substances such as antigens, antibodies specific for CODH, and other inhibitors of CODH such as nickel and molybdenum metal chelators. The methods and compositions are particularly suited for treatment of diseases from previously under recognized anaerobic or facultative anaerobic pathogens such as Mycobacterium tuberculosis and Mycobacterium pneumonia. Excerpt(s): This application is a continuation-in-part of U.S. Ser. No. 10/018,243, filed Dec. 18, 2001, which is a continuation of international application no. PCT/US00/16679, filed Jun. 19, 2000, which receives priority from provisional applications 60/206,518 filed May 22, 2000 and 60/194,766 filed Apr. 3, 2000. All prior applications are incorporated by reference in their entireties. This invention relates to compositions and methods for detecting, preventing and treating infectious diseases such as Mycobacterium tuberculosis ("M. TB"), M. pneumonia ("M. TP"), and to new classes of antibiotics effective against anaerobic and facultative anaerobic microorganisms. Treatment and prophylaxis of infectious diseases have been advanced tremendously by the discovery of antibiotics and vaccines. The discovery and implementation of antibiotics to kill bacteria has greatly increased human life span and the discovery of the role of the immune system in warding off and reversing viral disease has been exploited to great benefit by vaccination programs against those diseases. Despite those great successes, however, new modalities of action for antibiotics against the bacteria are needed in view of the development of resistance to those same antibiotics. At the same time, mankind's creativity and understanding of the molecular biology behind disease is challenged anew by the AIDS crisis. Despite almost two decades of intensive research there is still no cure for AIDS, though it appears that effective treatment for various infections, including HIV, that 30% , afflict AIDS patients prolongs their lives. Thus, modem society is faced with two major challenges: the prevention, treatment and detection of intractable disease such as tuberculosis, syphilis, and AIDS and the development of antibiotics that utilize new molecular modalities against bacteria that resist the old treatments. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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This has been a common practice outside the United States prior to December 2000.

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Diagnostic kit for simultaneously detecting multiple infectious diseases and the preparation thereof Inventor(s): Hu, Gengxi; (Shanghai, CN) Correspondence: Min (amy) S. XU; Dorsey & Whitney Llp; Intellectual Property Department; 50 South Sixth Street, Suite 1500; Minneapolis; MN; 55402-1498; US Patent Application Number: 20030165970 Date filed: March 21, 2003 Abstract: The present invention relates to a diagnostic kit for simultaneously detecting multiple infectious diseases and the preparation thereof. The kit comprises immunogold filtration assay device, buffer and the mixture of colloidal gold conjugates, wherein said immunogold filtration assay device comprises a nitrocellulose membrane comprising HBsAg monoclonal antibody, HCV antigen, syphilitic antigen, HIV antigen and goat anti-mouse IgG antibody applied thereon. The present invention has also disclosed the preparation of said diagnostic kit. The present invention bases on the colloidal immunogold filtration assay technique, and realizes the simultaneous detection of Hepatitis B, Hepatitis C, syphilis and AIDS on one carrier. It is easy to operate, rapid and accurate and suitable for detecting multiple diseases, especially for large scaled blood screens. It has also provided a new idea for the detection of infectious diseases. Excerpt(s): This application is a continuation of International Patent Application PCT/CN01/01519, filed on Oct. 30, 2001, which claims priority to Chinese Patent Application CN 01126500.0, filed on Aug. 17, 2001, the contents of which are hereby incorporated in their entirety by reference. This invention relates to the field of biotechnology, more particularly, to a diagnostic kit for simultaneously detecting multiple infectious diseases and the preparation thereof. Hepatitis B, Hepatitis C, syphilis and AIDS are four kinds of worldwide infectious diseases. According to the statistical materials from Ministry of Health, the incidence of these diseases occupies about 27.57% among the total incidence of infectious diseases, which does great harm to the public and people's living. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with syphilis, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “syphilis” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on syphilis. You can also use this procedure to view pending patent applications concerning syphilis. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 7. BOOKS ON SYPHILIS Overview This chapter provides bibliographic book references relating to syphilis. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on syphilis include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “syphilis” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on syphilis: •

AIDS: Historic Overview of Syphilis and Its Significance to Contemporary Medical Policy. Medical Library Association's 89th Annual Meeting Contact: Teach'em, Incorporated, 160 E Illinois, Chicago, IL, 60611, (312) 467-0424. Summary: In this sound recording of a session from the Medical Library Association's 89th Annual Meeting, the epidemic of Acquired immunodeficiency syndrome (AIDS), caused by the Human immunodeficiency virus (HIV), is discussed from the viewpoint of the medical historian. He says that the way society reacts to disease shows its deepest cultural, social, and moral values. He discusses the denial that existed in this country for a long time about the real causes of syphilis and gonorrhea. He says that there are many similarities between the way the public reacts to AIDS today and the reaction against syphilis and gonorrhea early in the 20th century. He says that the major public health campaigns used today were developed early in this century. He discusses the distinction made by the public between innocent and guilty victims of Sexually transmitted diseases (STD's). He compares this attitude to the distinction made today between

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Persons with AIDS (PWA's). He describes the effort to lower the STD rates during World War I by closing down the red light districts in 110 cities. Between 40,000 and 60,000 prostitutes were incarcerated in barbed-wire camps throughout the war, but the rate of STD's was not affected. He says that the social policy response to AIDS must be faced in the coming years. It must be decided what is safe and how risks can be compared. He discusses the involvement of the AIDS epidemic in the political process, which led to compulsory HIV testing for marriage-license applicants in Louisiana and Illinois. He concludes his discussion by saying that society needs a deeper medical and cultural understanding of the AIDS epidemic. A question-and-answer period follows the presentation. •

Syphilis Elimination Communication Plan Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for HIV STD and TB Prevention, 1600 Clifton Rd NE MS E06, Atlanta, GA, 30333, (404) 639-8063, http://www.cdc.gov/nchstp/od/nchstp.html. CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 458-5231, http://www.cdcnpin.org. Summary: This document lays out the communications goal, objectives, target audiences, and key strategies and tactics to support the National Plan to Eliminate Syphilis from the United States. It is based on a review of the literature on syphilis prevention and elimination; media coverage of the syphilis elimination program launch; key informant interviews; and meetings with the Centers for Disease Control and Prevention's (CDC) communications staff from the National Center for HIV, STD, and TB Prevention (NCHSTP), Office of the Director (OD), Division of STD Prevention (DSTD), and meetings of the DSTD Health Communications Working Group. It is important to keep in mind that the objectives, strategies, and tactics all relate to communications; the communication plan, while national in scope, focuses on the geographic areas with the most syphilis morbidity and where the potential for syphilis re-emergence is high; the communication plan must be dynamic and flexible to allow for changes over time; the strategies and tactics proposed are not exhaustive; and the implementation of the plan will require the commitment and involvement of many individuals and organizations. Steps in the health communication process are (1) planning and selecting strategies, (2) selecting channels and materials, (3) developing materials and pretesting, (4) implementing the program, (5) assessing the program's effectiveness, and (6) refining the program based on feedback. Audiences targeted for communication include policymakers, health care providers and associations, and community representatives, and key strategies for elimination are expanded surveillance and outbreak response activities, rapid screening in and out of medical settings, expanded laboratory services, strengthened community involvement and agency partnerships, and enhanced health promotion.

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Syphilis As AIDS Contact: Banned Books, PO Box 33280, Austin, TX, 78764, (512) 288-7515. Summary: This monograph advocates the theory that Acquired immunodeficiency syndrome (AIDS) is not a new disease; rather, it is a new manifestation of syphilis. The author, Robert Ben Mitchell, writes that over the centuries, syphilis has died down, then developed new strains with new symptoms that sweep through the population in epidemic proportions. Mitchell believes that the Human immunodeficiency virus (HIV) does not cause AIDS. The monograph goes into the history of syphilis, means of

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transmission, and its signs and symptoms. It explains that the U.S. protocol for syphilis is invalid, and that it can cause immune suppression. Mitchell says that worldwide AIDS research has taken the wrong path by becoming virus-oriented, and that the AIDS epidemic will not come under control as long as research maintains that focus. Appendixes present an antibiotic protocol for AIDS treatment by Dr. Stephen Caiazza, who treats it as syphilis; the text of a speech by Dr. Caiazza; and a related bibliography. •

Recommendations for Public Health Surveillance of Syphilis in the United States Summary: This monograph reports on updated syphilis surveillance guidelines for use in improving and developing syphilis surveillance techniques and making collection and reporting of syphilis surveillance data more uniform. The monograph discusses the purposes and uses of the two main components of syphilis surveillance: case reporting and prevalence monitoring. It also provides case definitions to be used for syphilis, reporting formats and intervals, and guidelines for provider-based and laboratory-based case reporting. The monograph includes guidelines for dissemination and communication of findings, information system design, privacy and data security, and training and personnel. Sample serology laboratory site visit report and annual clinical laboratory survey calendar year worksheets are appended.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “syphilis” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “syphilis” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “syphilis” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

AIDS and Syphilis: The Hidden Link by Harris L. Coulter (1987); ISBN: 1556430213; http://www.amazon.com/exec/obidos/ASIN/1556430213/icongroupinterna

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Bad Blood Tuskegee Syphilis Experiment by Jones, James Howard Jones; ISBN: 0029166764; http://www.amazon.com/exec/obidos/ASIN/0029166764/icongroupinterna

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Bad Blood: The Tuskegee Syphilis Experiment a Race of Race and Medicine by James Howard Jones (1982); ISBN: 002916690X; http://www.amazon.com/exec/obidos/ASIN/002916690X/icongroupinterna

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Chicago's War on Syphilis, 1937-1940: The Times, the Trib, and the Clap Doctor by Suzanne Poirier (1995); ISBN: 0252021479; http://www.amazon.com/exec/obidos/ASIN/0252021479/icongroupinterna

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De la syphilis au Sida: cinq siecles des memoires litteraires de Venus by Jean Goens; ISBN: 9052015082; http://www.amazon.com/exec/obidos/ASIN/9052015082/icongroupinterna

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Disease costs of tuberculosis and syphilis in Australia : a discussion paper; ISBN: 0644455993; http://www.amazon.com/exec/obidos/ASIN/0644455993/icongroupinterna

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Disease in the Popular American Press: The Case of Diphtheria, Typhoid Fever, and Syphilis, 1870-1920 (Contributions in Medical Studies) by Terra Ziporyn (Author) (1988); ISBN: 0313260354; http://www.amazon.com/exec/obidos/ASIN/0313260354/icongroupinterna

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Final report of the Tuskegee Syphilis Study Ad Hoc Advisory Panel (SuDoc HE 20.2:T 87) by U.S. Dept of Health and Human Services; ISBN: B00010XYFM; http://www.amazon.com/exec/obidos/ASIN/B00010XYFM/icongroupinterna

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Fracastoro's Syphilis. Introduction, Text, Translation and Notes (ARCA, Classical and Medieval Texts, Papers and Monographs 12) by Geoffrey Eatough; ISBN: 0905205200; http://www.amazon.com/exec/obidos/ASIN/0905205200/icongroupinterna

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Fundamental skills in serology : agglutination tests, syphilis serology, fluorescent staining by Leila J. Walker; ISBN: 0398035105; http://www.amazon.com/exec/obidos/ASIN/0398035105/icongroupinterna

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God's Judgment? Syphilis and AIDS: Comparing the History and Prevention Attempts of Two Epidemics by Perry Treadwell (2001); ISBN: 059520239X; http://www.amazon.com/exec/obidos/ASIN/059520239X/icongroupinterna

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Gonorrhea and Syphilis - 1912: A Drugless Treatment of Veneral Diseases by J. H. Tilden, Dr John H. Tilden (1997); ISBN: 1564598756; http://www.amazon.com/exec/obidos/ASIN/1564598756/icongroupinterna

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Gonorrhea and Syphilis: A Drugless Treatment (1993); ISBN: 078730879X; http://www.amazon.com/exec/obidos/ASIN/078730879X/icongroupinterna

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Gonorrhoea and Syphilis by J.H. Tilden; ISBN: 1858103215; http://www.amazon.com/exec/obidos/ASIN/1858103215/icongroupinterna

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Handbook of Endemic Treponematoses: Yaws, Endemic Syphilis and Pinta by Peter L. Perine; ISBN: 9241541768; http://www.amazon.com/exec/obidos/ASIN/9241541768/icongroupinterna

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Im Kampf gegen Pocken, Tollwut, Syphilis : das Leben von Edward Jenner, Louis Pasteur, Paul Ehrlich by Huldrych M. Koelbing; ISBN: 3718503964; http://www.amazon.com/exec/obidos/ASIN/3718503964/icongroupinterna

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Pox: Genius, Madness, and the Mysteries of Syphilis by Deborah Hayden; ISBN: 0465028810; http://www.amazon.com/exec/obidos/ASIN/0465028810/icongroupinterna

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Prostitution : eine sozialgeschichtliche Untersuchung in Frankfurt a.M. : von der Syphilis bis AIDS by Margot D. Kreuzer; ISBN: 3892720320; http://www.amazon.com/exec/obidos/ASIN/3892720320/icongroupinterna

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Protect yourself from the storm hepatitis B, herpes, gonorrhea, genital warts, chlamydia, syphilis, AIDS (SuDoc D 2.9:D 36/2/NO.111) by U.S. Dept of Defense; ISBN: B00010UV0I; http://www.amazon.com/exec/obidos/ASIN/B00010UV0I/icongroupinterna

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Serological Tests for Syphilis (Illustrated Laboratory Techniques Series, Vol 2) by Takayuki Tomizawa; ISBN: 0896400638; http://www.amazon.com/exec/obidos/ASIN/0896400638/icongroupinterna

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Sexually Transmitted Diseases Sourcebook: Basic Information About Herpes, Chlamydia, Gonorrhea, Hepatitis, Nongonoccocal Urethritis, Pelvic Inflammatory Disease, Syphilis, AIDS, and More (Health Reference Series, Vol 26) by Linda M. Ross

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(Editor), Peter Dresser (Editor) (1997); ISBN: 0780802179; http://www.amazon.com/exec/obidos/ASIN/0780802179/icongroupinterna •

Shakespeare and the New Disease: The Dramatic Function of Syphilis in Troilus and Cressida, Measure for Measure, and Timon of Athens (American Unive) by Greg W. Bentley (1989); ISBN: 0820408174; http://www.amazon.com/exec/obidos/ASIN/0820408174/icongroupinterna

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Surgery, Skin And Syphilis: Daniel Turner's London (1667-1741). (Clio Medica/The Wellcome Institute Series in the History of Medicine 54) by Phillip K. Wilson, Philip K. Wilson (1999); ISBN: 9042005262; http://www.amazon.com/exec/obidos/ASIN/9042005262/icongroupinterna

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Syphilis by Edward W. Hook III MD (Editor), Sheila A. Lukehart PhD (Editor); ISBN: 0865422192; http://www.amazon.com/exec/obidos/ASIN/0865422192/icongroupinterna

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Syphilis by Patrick Wald Lasowski (Author); ISBN: 2070290611; http://www.amazon.com/exec/obidos/ASIN/2070290611/icongroupinterna

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Syphilis (Deadly Diseases and Epidemics) by Brian Shmaefsky, et al; ISBN: 0791073084; http://www.amazon.com/exec/obidos/ASIN/0791073084/icongroupinterna

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Syphilis (SuDoc HE 20.3252:SE 9/3/992/SYPH.) by U.S. Dept of Health and Human Services; ISBN: B00010CUWK; http://www.amazon.com/exec/obidos/ASIN/B00010CUWK/icongroupinterna

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Syphilis and Other Sexually Transmitted Diseases by Holly Cefrey; ISBN: 0823934888; http://www.amazon.com/exec/obidos/ASIN/0823934888/icongroupinterna

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Syphilis and Other Venereal Diseases by Brown; ISBN: 0674861221; http://www.amazon.com/exec/obidos/ASIN/0674861221/icongroupinterna

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Syphilis As AIDS by Robert Ben Mitchell (1990); ISBN: 0934411352; http://www.amazon.com/exec/obidos/ASIN/0934411352/icongroupinterna

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Syphilis in Shakespeare's England by Johannes Fabricius (1994); ISBN: 1853022705; http://www.amazon.com/exec/obidos/ASIN/1853022705/icongroupinterna

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Syphilis Serology: Principles and Practice by Gerald D. Wasley, Helen H.Y. Wong; ISBN: 0192615300; http://www.amazon.com/exec/obidos/ASIN/0192615300/icongroupinterna

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Syphilis, Puritanism and Witch Hunts: Historical Explanations in the Light of Medicine and Psychoanalysis With a Forecast About AIDS by Stanislav Andreski; ISBN: 0312027028; http://www.amazon.com/exec/obidos/ASIN/0312027028/icongroupinterna

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Syphilis: A Manual of Tests and Supplement by Sandra A. Larsen (Editor), et al (1999); ISBN: 0875532349; http://www.amazon.com/exec/obidos/ASIN/0875532349/icongroupinterna

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Syphilis: A Synopsis by U.S. Public Health Service (Editor), et al (2001); ISBN: 0898753929; http://www.amazon.com/exec/obidos/ASIN/0898753929/icongroupinterna

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The Colour of Disease: Syphilis and Racism in South Africa, 1880-1950 (St. Antony's) by Karen Jochelson (2001); ISBN: 0333740440; http://www.amazon.com/exec/obidos/ASIN/0333740440/icongroupinterna

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The History of Syphilis by Claude Quetel, et al (1992); ISBN: 0801843928; http://www.amazon.com/exec/obidos/ASIN/0801843928/icongroupinterna

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The Legend of Nietzsche's Syphilis: (Contributions in Medical Studies) by Richard Schain (Author); ISBN: 0313319405; http://www.amazon.com/exec/obidos/ASIN/0313319405/icongroupinterna

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The Official Patient's Sourcebook on Syphilis: A Revised and Updated Directory for the Internet Age by Icon Health Publications (2002); ISBN: 0597833109; http://www.amazon.com/exec/obidos/ASIN/0597833109/icongroupinterna

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The Tuskegee Syphilis Study: The Real Story and Beyond by Fred D. Gray; ISBN: 1588380890; http://www.amazon.com/exec/obidos/ASIN/1588380890/icongroupinterna

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Thrust Syphilis Down to Hell and Other Rejoyceana Studies in Borderlands of Literature and Medicine by J.B. Lyons (1988); ISBN: 0907606377; http://www.amazon.com/exec/obidos/ASIN/0907606377/icongroupinterna

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Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study (Studies in Social Medicine) by Susan M. Reverby (Editor) (2000); ISBN: 0807848522; http://www.amazon.com/exec/obidos/ASIN/0807848522/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “syphilis” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 •

A manual for serological tests for syphilis. Author: California. Dept. of Public Health. Division of Laboratories.; Year: 1957; [Berkeley] Stete of California, Dept. of Public Health, Microbiology Laboratory, Laboratory Field Services, 1962

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Arthro-syphilis congenita tardiva et acquisita et arthro-metasyphilis. Author: Sundt, Halfdan.; Year: 1965; Oslo, 1948

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Autopsy studies in syphilis; a monograph. Author: Rosahn, Paul D.; Year: 1964; [Washington, 1947]

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Cerebrospinal fluid protein in syphilis; a methodological and clinical study, based on the Izikowitz method for fractional protein determination, and a comparison with paper electrophoretic protein determination. [Tr. from the Swedish]. Author: Flodén, Carl Henrik Axelsson,; Year: 1951; Stockholm, 1955

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In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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Manual of serologic tests for syphilis. Author: United States. Public Health Service. Venereal Disease Research Laboratory, Stapleton, N. Y.; Year: 1934; [Washington] 1949

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Manual of tests for syphilis. Author: Venereal Disease Program (National Communicable Disease Center); Year: 1952; Atlanta [For sale by the Supt. of Docs., U. S. Govt. Print. Off., Washington] 1969

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Reiter protein complement-fixation (RPCF) test as a serological test for syphilis; a clinical study. [Translated by Gunvor Hustich, in co-operation with Jean M. Perttunen]. Author: Förström, Lars.; Year: 1967; Helsinki, 1967

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Report on evaluation of prevention and control of syphilis in pregnancy projects in Chipata, Kitwe, Livingstone, Lusaka, and Ndola, September to November 1998. Author: UNICEF Zambia.; Year: 1951; [Lusaka: s.n., 1998]

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Spirochetes in late seronegative syphilis, penicillin notwithstanding. Author: Smith, J. Lawton (Joseph Lawton),; Year: 1967; Springfield, Ill., Thomas [c1969]

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Studies on interstitial keratitis associated with congenital syphilis occurring in Finland. Author: Oksala, A. (Arvo); Year: 1955; Helsinki, 1951

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Syphilis and gonorrhea; a manual for physicians. Author: Canada. Dept. of National Health and Welfare.; Year: 1957; Ottawa, Dept. of National Health and Welfare, 1967]

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Syphilis, a synopsis. Author: Venereal Disease Program (National Communicable Disease Center); Year: 1966; Atlanta [For sale by the Supt. of Docs., U. S. Govt. Print. Off., Washington, 1968]

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The laboratory aspects of syphilis. Author: Venereal Disease Program (National Communicable Disease Center); Year: 1949; Atlanta [For sale by the Supt. of Docs., U. S. Govt. Print. Off., Washington, 1967]

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The Oslo study of untreated syphilis; an epidemiologic investigation of the natural course of the syphilitic infection based upon a re-study of the Boeck-Bruusgaard material. Author: Gjestland, Trygve.; Year: 1953; Oslo, Akademisk forlag, 1955

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The serum diagnosis of syphilis. The Wassermann and Sigma reactions compared. Author: Medical Research Council (Great Britain); Year: 1969; London, H. M. Stationery off., 1923

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Transactions of the International Symposium on the Study of Syphilis, Helsinki, Finland, 4-10 September, 1950, held under the auspices of the State Medical Board of Finland and the World Health Organization. Author: Finland. Lääkintöhallitus.; Year: 1955; Helsinki, Mercatorin Kirjapaino, 1951

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Treponemal and lipoidal tests in old treated syphilis; a clinical evaluation of 367 cases, with special reference to the fluorescent treponemal antibody-absorption (FTAABS) test. Author: Lassus, Allan.; Year: 1964; Helsinki, 1968

Chapters on Syphilis In order to find chapters that specifically relate to syphilis, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and syphilis using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “syphilis” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on syphilis:

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Otosyphilis and Otologic Manifestations of AIDS Source: in Canalis, R.F. and Lambert, P.R., eds. Ear: Comprehensive Otology. Philadelphia, PA: Lippincott Williams and Wilkins. 2000. p. 587-599. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030. Fax (301) 223-2300. Website: www.lww.com. PRICE: $179.00 plus shipping and handling. ISBN: 078171558X. Summary: Although syphilis was particularly prevalent in the prepenicillin ear, its current role in ear pathology, particularly in sensorineural hearing loss, demands renewed attention. This chapter on otosyphilis and the otologic manifestations of AIDS is from a textbook that offers complete coverage of the field of clinical otology (study of the ear). The book is oriented to serve both the otolaryngology resident as a practical learning tool and the practicing otolaryngologist as an updated reference source of clinical and basic information. Topics include incidence, pathology, clinical features, diagnosis, treatment, and otologic manifestations in HIV infection and AIDS, including background and pathophysiology of HIV infection, temporal bone studies, and otologic manifestations in HIV infection. Clinical features of otosyphilis including hearing loss, tinnitus (ringing or other sounds in the ears), and dizziness in varying degrees. Hearing loss may fluctuate and disproportionately affect speech discrimination. Otosyphilis is treated with prolonged high dose penicillin and prednisone (prednisone may be withheld in immunocompromised patients). Patients with HIV may have syphilis from before their HIV infection or may have coincident (at the same time) syphilis infection. If HIV status is unknown, patients with suspected otosyphilis should be tested for HIV. 6 figures. 111 references.

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CHAPTER 8. MULTIMEDIA ON SYPHILIS Overview In this chapter, we show you how to keep current on multimedia sources of information on syphilis. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on syphilis is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “syphilis” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “syphilis” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on syphilis: •

Gotcha! From the Mouth of Syphilis and Crack Cocaine Contact: Youth Unlimited Productions, PO Box 16433, Portland, OR, 97233, (503) 2848082. Summary: A teen dramatization about drug abuse and sexually transmitted diseases (STD), this video recording stresses safer sexual practices for STD and AIDS prevention. A teen narrates the story of her friend, Toni, who abuses cocaine, does not use condoms, and has syphilis. The teen, another friend, and Toni's mother try to convince Toni to seek treatment. Gradually, Toni begins to take responsibility and uses condoms, but she gets arrested and ordered into drug treatment. The mother narrates a list of ways to prevent STDs including: practicing abstinence, limiting the number of sexual partners, and using condoms. Avoiding drugs is emphasized as well. An instructional guide is included.

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Syphilis: The Hidden Devastator Contact: NIMCO, PO Box 9, Calhoun, KY, 42327-0009, (502) 273-5050. Summary: This video provides information about the sexually transmitted disease (STD), syphilis. The video discusses syphilis, its transmission, long-term effects if left untreated, diagnosis and treatment. The video also discusses the emotional effects upon individuals infected with syphilis.

Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” Type “syphilis” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on syphilis: •

America Responds to AIDS -- Radio PSA's: New York Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National AIDS Information and Education Program, Bldg 1 Rm 2122, 1600 Clifton Rd NE, Atlanta, GA, 30333, (404) 639-2928. Summary: In this sound recording of a radio public service announcement (PSA), three New Yorkers give warnings about the dangers of contracting Human immunodeficiency virus (HIV) and/or Acquired immunodeficiency syndrome (AIDS) from sexual partners. An AIDS counselor notes that deciding to have sex is potentially exposing oneself to HIV, but that unlike gonorrhea and syphilis, there is no cure for AIDS. A nurse counselor says that even one sexual encounter could lead to infection. A minority AIDS project worker says there is a problem with young people not knowing how to protect themselves against AIDS, and so efforts must be made to inform them. An announcer notes that AIDS affects everyone, and urges listeners to learn the facts about AIDS to protect themselves and their families.

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Typhoid Vaccine: Advanced Immune Discoveries Symposium Contact: Human Energy Press, 493 Beach Park Blvd Ste 210, Foster City, CA, 94404, (415) 349-0718. Summary: This sound recording deals with the use of typhoid vaccine to treat Human immunodeficiency virus infection (HIV) and Acquired immunodeficiency syndrome (AIDS). The vaccine works best when it is started when symptoms are still mild. Azidothymidine (AZT), pentamidine, and acyclovir must be discontinued. Positive reactions to the test for syphilis were common among the participants in the study. Side effects of the treatment are discussed, as is the use of germanium to control them. Several case studies are included.

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AIDS in ENT Contact: California Medical Association, Audio Digest Foundation, 1577 E Chevy Chase Dr, Glendale, CA, 91206, (213) 245-8505.

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Summary: This sound recording, along with accompanying pre-test and post-test questions, is part of an ongoing series of educational activities. The first speaker, James S. Atkins Jr. of Wilford Hall United States Air Force Medical Center in San Antonio, TX, discusses Human immunodeficiency virus (HIV) infection and sensorineural hearing loss. His presentation deals with subclinical signs of infection and the etiology of the loss. Darius Kohan, Senior Resident in the Deparment of Otolaryngology at New York University Medical Center in New York City, looks at otologic manifestations of Acquired immunodeficiency syndrome (AIDS). Next, Marshall E. Smith, of the Division of Head and Neck Surgery at the University of California Los Angeles Medical Center, examines the neurosyphilis connection. The possibility of HIV transmission through otologic homografts is explored by Glenn W. Knox of the Department of Otolaryngology at Vanderbilt University Medical Center in Nasvhille, TN. Pneumocystis carinii pneumonia (PCP) plays a role in the next presentation, on AIDS and the Bronchoesophagologist. This presentation also looks at oral cavity lesions and cutaneous Kaposi's sarcoma. Michael J. Lanser, Chief Resident of the Department of Otolaryngology/Head and Neck Surgery at the University of California San Francisco Medical Center gives a presention on rhinosporidiosis and other rhinologic manifestations. The final segment, given by Jan Wersall, professor of otolaryngology at Karolinski Institute in Stockholm, deals with personal integrity and protection of patients, health care personnel, and the population in Sweden.

Bibliography: Multimedia on Syphilis The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in syphilis (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on syphilis: •

[Fight syphilis] [motion picture] Source: presented by U.S. Public Health Service, Federal Security Agency; a Sound Masters production; Year: 1942; Format: Fight syphilis; [United States]: The Service, [1942]

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Clinical aspects of syphilis [videorecording] Source: Department of Medicine, Emory University, School of Medicine; Year: 1979; Format: Videorecording; Atlanta: Emory Medical Television Network: [for loan or sale by A. W. Calhoun Medical Library], 1979

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Early infectious syphilis and its differential diagnosis [videorecording] Source: Academy of Health Sciences, Health Sciences Media Division; produced and distributed by the Institute for Dermatologic Communication and Education; Year: 1979; Format: Videorecording; San Francisco, Calif.: The Institute, c1979

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How can syphilis be prevented? [motion picture] Source: [United States Public Health Service]; Year: 1944; Format: Motion picture; United States: The Surgeon General, United States Public Health Service, [1944]

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Microhemagglutination assay methods in the diagnosis of syphilis [sound recording] Source: [developed by Laboratory Training and Consultation Division, Bureau of Laboratories]; Year: 1980; Format: Sound recording; Batavia, Ill.: NCCE, [1980?]

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Practical points in the treatment of syphilis [motion picture] Source: Paul A. O'Leary and Louis A. Brunsting; Year: 1937; Format: Motion picture; [United States?: s.n., 1937]

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Skin signs of syphilis [slide] Source: McMaster University Health Sciences; Year: 1972; Format: Slide; [Hamilton, Ont.]: Health Sciences McMaster Univ.], 1972

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Syphilis: a reappraisal [videorecording] Source: Georgia Regional Medical Television Network; Year: 1974; Format: Videorecording; [Atlanta]: The Network: [for loan by A. W. Calhoun Medical Library], 1974

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Syphilis [motion picture]: a motion picture clinic Source: produced jointly by the American Medical Assn. and the United States Public Health Service, under the auspices of the Board of Trustees of the American Medical Assn.; produced by Burton Holmes Films,; Year: 1937; Format: Motion picture; [Washington, D.C.?]: The Service, [1937]

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Syphilis [motion picture]: management of syphilis in general practice Source: United States Public Health Service; Year: 1942; Format: Motion picture; United States: The Service, 1942

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Syphilis [slide]. Year: 1986; Format: Slide; [S.l.: s.n., 1986]

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Syphilis [slide]. Year: 1986; Format: Slide; [S.l.: s.n., 1986]

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Syphilis [slide]. Year: 1989; Format: Slide; New York, N.Y.: Gower Medical Pub., c1989

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Syphilis [videorecording] Source: presented by Department of Medicine, Emory University, School of Medicine; Year: 1987; Format: Videorecording; Atlanta, Ga.: The University, c1987

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Syphilis and gonorrhea [filmstrip] Source: Trainex Corporation; Year: 1974; Format: Filmstrip; Garden Grove, Calif.: Trainex, c1974

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Syphilis and gonorrhea [videorecording] Source: Trainex Corporation; Year: 1974; Format: Videorecording; Garden Grove, Calif.: Trainex, c1974

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V.D. & syphilis [slide] Source: A. P. Ulbrich. v d and syphilis; Year: 1978; Format: Slide; East Lansing, Mich.: Michigan State Univ.: [for sale by its Instructional Media Center, Marketing Division], c1978

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With these weapons [motion picture]: the story of syphilis Source: as told by David Ross; presented by the National Anti-syphilis Committee of the American Social Hygiene Association; produced by Willard Pictures; Year: 1939; Format: Motion picture; [United States]: The Association, c1939

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CHAPTER 9. PERIODICALS AND NEWS ON SYPHILIS Overview In this chapter, we suggest a number of news sources and present various periodicals that cover syphilis.

News Services and Press Releases One of the simplest ways of tracking press releases on syphilis is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “syphilis” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to syphilis. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “syphilis” (or synonyms). The following was recently listed in this archive for syphilis: •

U.S. syphilis rates climb for the second year Source: Reuters Health eLine Date: November 20, 2003

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U.S. syphilis rates climb for the second year in a row Source: Reuters Medical News Date: November 20, 2003

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Syphilis rates soar in Britain Source: Reuters Health eLine Date: August 01, 2003

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Gay men meeting online contracting syphilis faster Source: Reuters Health eLine Date: June 19, 2003

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Rates of syphilis soar in Italy: experts Source: Reuters Health eLine Date: March 21, 2003

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LA syphilis cases grow amid calls for education Source: Reuters Health eLine Date: December 27, 2002

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Syphilis rates in US turn upward for first time in a decade Source: Reuters Medical News Date: October 31, 2002

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Syphilis rates in US men up in 2001, reversing trend Source: Reuters Health eLine Date: October 31, 2002

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Syphilis 'epidemic' seen among gay men in Germany Source: Reuters Health eLine Date: October 09, 2002

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Germany reports sharp rise in syphilis among gay men, perhaps via oral sex Source: Reuters Medical News Date: October 08, 2002

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Syphilis among gay, bisexual men on the rise in NYC Source: Reuters Health eLine Date: September 26, 2002

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Number of syphilis cases in NYC up sharply, primarily among gay/bisexual me Source: Reuters Medical News Date: September 26, 2002

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UK rise in syphilis sparks calls for surveillance Source: Reuters Health eLine Date: July 19, 2002

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Increasing UK syphilis rates spark calls for surveillance Source: Reuters Medical News Date: July 19, 2002

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Don't forget neurosyphilis, researcher warns docs Source: Reuters Health eLine Date: June 26, 2002

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CORRECTION: Syphilis tests may aid treatment of newborns: study Source: Reuters Health eLine Date: June 07, 2002

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Infant deaths from syphilis still a problem in US Source: Reuters Health eLine Date: May 29, 2002

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Infant mortality associated with congenital syphilis remains a problem in US Source: Reuters Medical News Date: May 28, 2002

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US syphilis rate hit all-time low in 2000 Source: Reuters Medical News Date: November 28, 2001

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Syphilis hits all-time low in the US: CDC Source: Reuters Health eLine Date: November 28, 2001

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Coexistent HIV ups likelihood that genital ulcers are due to syphilis Source: Reuters Medical News Date: September 13, 2001

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Condom use reduced heterosexual transmission of HIV, syphilis in US in 1990s Source: Reuters Medical News Date: August 01, 2001

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US congenital syphilis cases halved in 3 years Source: Reuters Health eLine Date: July 12, 2001

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Rate of US congenital syphilis cases cut in half Source: Reuters Medical News Date: July 12, 2001

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HIV-infected moms likely to pass along syphilis Source: Reuters Health eLine Date: July 11, 2001

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FDA expands Trinity's CAPTIA indication to include primary syphilis diagnosis Source: Reuters Industry Breifing Date: April 18, 2001

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Manifestations of syphilis similar in HIV-infected and uninfected subjects Source: Reuters Medical News Date: March 14, 2001

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US syphilis rates declining Source: Reuters Health eLine Date: February 22, 2001

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US syphilis rates down, gonorrhea rates up Source: Reuters Health eLine Date: December 05, 2000

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Internet chatters fight LA syphilis outbreak Source: Reuters Health eLine Date: November 17, 2000

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Anonymous Internet chatters address syphilis outbreak in Los Angeles Source: Reuters Medical News Date: November 16, 2000

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Ceftriaxone may be alternative treatment for neurosyphilis in HIV-infected patients Source: Reuters Medical News Date: April 26, 2000

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Syphilis patients are critical targets for HIV prevention efforts Source: Reuters Medical News Date: February 08, 2000

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Syphilis increases HIV-1 risk by inducing CCR5 expression Source: Reuters Medical News Date: January 12, 2000

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Lowest syphilis rate ever recorded in US reported by CDC Source: Reuters Medical News Date: October 08, 1999

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US syphilis rates hit record low, elimination possible Source: Reuters Health eLine Date: October 07, 1999

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Single-dose alternative to penicillin for preventing syphilis Source: Reuters Health eLine Date: September 22, 1999

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Oral azithromycin equivalent to intramuscular penicillin for syphilis prevention Source: Reuters Medical News Date: September 21, 1999 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “syphilis” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests.

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Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “syphilis” (or synonyms). If you know the name of a company that is relevant to syphilis, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “syphilis” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “syphilis” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on syphilis: •

Antiphospholipid Syndrome: What We Know Today and What the Future Holds Source: Lupus News. 20(5): 14-16. Winter 2000. Contact: Available from Lupus Foundation of America. 1300 Piccard Drive, Suite 200, Rockville, MD 20850-4303. (800) 558-0121 or (301) 670-9292. Fax (301) 670-9486. Website: www.lupus.org/lupus. Summary: This newsletter article provides people who have lupus with information on the antiphospholipid syndrome (APLS). This blood clotting disorder affects many people who have lupus. People who have APLS develop antibodies to structures in the membranes of cells that line the bloodstream, and these antibodies, known as antiphospholipid (APL) antibodies, interfere with important blood clotting proteins. The article reviews some historical findings that may help explain APLS, including the finding in the 1940s that women with lupus were testing positive for syphilis, the finding in 1948 that some patients with lupus with blood clotting problems had a particular antibody in their blood that increased clotting time in a test tube, and the identification in the 1980s of several antiphospholipid antibodies. There are several tests available to help diagnose APLS, including several versions of the lupus anticoagulant test, tests that directly measure antibodies to phospholipids or associated blood clotting proteins, and a test that measures antibodies to beta-2 glucoprotein 1. Several kinds of therapies are used to prevent future clots once a person has been diagnosed with the APLS, including avoiding the use of medications that may increase blood clotting risk and taking extra precautions in situations that may provoke blood clotting. People who

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have tested positive for lupus anticoagulant or anticardiolipin antibody but have never had a blood clot may be prescribed one aspirin per day. People who have experienced a blood clot traditionally have been prescribed warfarin, but use of this medication can be problematic because of its drug and food interactions. Although new drugs are in development for APLS and alternative therapies are available, there are significant impediments to research on the disorder. 1 table.

Academic Periodicals covering Syphilis Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to syphilis. In addition to these sources, you can search for articles covering syphilis that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 10. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for syphilis. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with syphilis. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to syphilis: Antihistamines •

Systemic - U.S. Brands: Aller-Chlor; AllerMax Caplets; Aller-med; Atarax; Banophen; Banophen Caplets; Benadryl; Benadryl Allergy; Bromphen; Calm X; Chlo-Amine; Chlorate; Chlor-Trimeton; Chlor-Trimeton Allergy; Chlor-Trimeton Repetabs; Claritin; Claritin Reditabs; Compoz; Conta http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202060.html

Doxycycline •

Dental - U.S. Brands: Atridox http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203716.html

Probenecid •

Systemic - U.S. Brands: Benemid; Probalan http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202480.html

Spectinomycin •

Systemic - U.S. Brands: Trobicin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202530.html

Spermicides •

Vaginal - U.S. Brands: Advantage 24; Because; Conceptrol Contraceptive Inserts; Conceptrol Gel; Delfen; Emko; Emko Pre-Fil; Encare; Gynol II Extra Strength Contraceptive Jelly; Gynol II Original Formula Contraceptive Jelly; Koromex Cream; Koromex Crystal Clear Gel; Koromex Fo http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202531.html

Tetracyclines •

Systemic http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202480.html

•

Systemic - U.S. Brands: Achromycin V; Declomycin; Doryx; Dynacin; Minocin; Monodox; Terramycin; Vibramycin; Vibra-Tabs http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202552.html

•

Topical - U.S. Brands: Achromycin; Aureomycin; Meclan; Topicycline http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202553.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

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Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

12

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.13 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:14 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

13 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 14 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “syphilis” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “syphilis” (or synonyms) into the “For these words:” box. The following is a sample result: •

The National Plan to Eliminate Syphilis From the United States Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for HIV STD and TB Prevention, 1600 Clifton Rd NE MS E06, Atlanta, GA, 30333, (404) 639-8063, http://www.cdc.gov/nchstp/od/nchstp.html. CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 458-5231, http://cdcnpin.org. Summary: This report consists of a plan that is intended to serve as a resource and blueprint for the many partners vital to the success of the effort to eliminate syphilis in the United States (US). Syphilis elimination in the US is within reach, as syphilis is easy to detect and cure, is at the lowest rate ever recorded, and is confined to a limited number of geographic areas. Yet syphilis remains a public health problem in a number of US counties and disproportionately affects African Americans living in poverty. Elimination of syphilis would remove two devastating consequences of the disease: increased likelihood of HIV transmission and compromised ability to have healthy babies. The national goal, based on definitions of syphilis elimination at national and local levels established by the Centers for Disease Control and Prevention (CDC), is to reduce syphilis cases to 1,000 or fewer and to increase the number of syphilis-free counties to 90% by 2005. This syphilis elimination initiative focuses on areas with high syphilis morbidity and areas with potential for syphilis re-emergence. Five strategies are critical for eliminating syphilis from the US; cross-cutting strategies include enhanced surveillance and strengthened community involvement and partnerships, and intervention strategies include rapid outbreak response, expanded clinical and laboratory services, and enhanced health promotion. Appendixes provide definitions of each of these strategies and highlight the roles of state and local health departments, federal government agencies, public and private service providers, correction facilities, community organizations, and national councils, associations, and coalitions in each strategy. Six support activities have also been identified: sustained STD/HIV prevention programs, committed leadership and program management, communications, quality assurance, evaluation, and training. Other topics covered include syphilis projections through 2005, elements of a health communication plan, resources and support required for elimination, historic milestones for syphilis elimination, the CDC's report to Congress on syphilis elimination in the US, syphilis in African Americans in the

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Southern US, and the CDC's 1998 consultation on the development of elimination strategies. •

Syphilis, Crack and AIDS: Rural Georgia's New Epidemic Contact: Georgia Department of Human Resources, Division of Public Health, Southeast Health District Office, 1101 Church St, Waycross, GA, 31501-3525, (912) 285-6002, http://www.ph.dhr.state.ga.us/regional/southeast/. Summary: This report looks at the growing use of crack cocaine in rural Georgia and its connection with the epidemics of syphilis and Acquired immunodeficiency syndrome (AIDS). It says that in the past four years, drug-related offenses by juveniles have increased 80 percent, and that State treatment centers have been overwhelmed with crack addicts. The incidence of syphilis has shown a 1000 percent increase, due to the process of trading sex for drugs and having multiple, often anonymous, partners. The report also shows that two out of every 1,000 live births are to women who have tested positive for Human immunodeficiency virus (HIV) infection. It says that racism, poverty, homelessness, alienation from society, unemployment and hopelessness are all factors.

•

Recommendations for Diagnosing and Treating Syphilis in HIV - Infected Patients Source: Morbidity and Mortality Weekly Report; Vol. 37, no. 39. Contact: US Government Printing Office, PO Box 371954, Pittsburgh, PA, 15250-7954, (202) 512-1800, http://www.access.gpo.gov. Massachusetts Medical Society, Medical Publishing Group, CSPO Box 9121, Waltham, MA, 02254, (800) 843-6356. Summary: This report makes recommendations that deal with treating syphilis in patients that are co-infected with the Human immunodeficiency virus (HIV). It suggests that all persons with HIV infection acquired through sexual contact or drug abuse be tested for syphilis, and that all sexually active persons with syphilis be tested for HIV. The report says treatment failures occur more often in patients with both infections. Additional recommendations deal with methods of treatment of syphilis; suggestions for needed research are made.

•

Congenital Syphilis - New Jersey Source: Morbidity and Mortality Weekly Report; Vol. 25, 1995; March 24, 1995. Contact: US Government Printing Office, PO Box 371954, Pittsburgh, PA, 15250-7954, (202) 512-1800, http://www.access.gpo.gov. Summary: To monitor disease burden and trends associated with congenital syphilis (CS), effective prevention programs require a surveillance system that identifies CS cases in an accurate and timely manner. Before 1988, comprehensive CS surveillance was difficult for health departments to conduct because documentation of infection in infants required complex and costly long-term follow-up for up to 1 year after delivery; follow-up often was incomplete, and many infected infants were not identified. To estimate the public health burden of CS more accurately and eliminate long-term followup of infants by health department personnel, in 1988 CDC implemented a new CS case definition (1). Rather than relying on documentation of infection in the infant, the new case definition presumes that an infant is infected if it cannot be proven that an infected mother was adequately treated for syphilis before or during pregnancy (2). During 19931994, the Sexually Transmitted Disease Prevention and Control Program of the New Jersey Department of Health (NJDOH) evaluated its CS surveillance system to assess the

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accuracy and completeness of reporting using the new case definition and to determine the personnel costs associated with identifying and classifying CS cases. This report summarizes the results of the evaluation.

The NLM Gateway15 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “syphilis” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 19442 2199 497 1474 7 23619

HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.19 Simply search by “syphilis” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

15

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

16

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 18 19

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

20 Adapted 21

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on syphilis can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to syphilis. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to syphilis. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “syphilis”:

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•

Guides on syphilis Syphilis http://www.nlm.nih.gov/medlineplus/syphilis.html

•

Other guides AIDS http://www.nlm.nih.gov/medlineplus/aids.html Chlamydia Infections http://www.nlm.nih.gov/medlineplus/chlamydiainfections.html Laboratory Tests http://www.nlm.nih.gov/medlineplus/laboratorytests.html Sexually Transmitted Diseases http://www.nlm.nih.gov/medlineplus/sexuallytransmitteddiseases.html

Within the health topic page dedicated to syphilis, the following was listed: •

General/Overviews Facts on Syphilis Source: National Center for HIV, STD, and TB Prevention, Division of STD Prevention http://www.cdc.gov/std/media/FactsSyph11-28-01.htm Information to Live By: Syphilis Source: American Social Health Association http://www.ashastd.org/stdfaqs/syphilis.html

•

Diagnosis/Symptoms Syphilis Test Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/syphilis/test.html

•

Specific Conditions/Aspects Tabes Dorsalis Source: National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/health_and_medical/disorders/tabes_dorsalis.htm

•

Latest News U.S. Syphilis Rates Climb for Second Consecutive Year Source: 11/20/2003, Centers for Disease Control and Prevention http://www.cdc.gov/od/oc/media/pressrel/r031120.htm U.S. Syphilis Rates Climb for the Second Year Source: 11/20/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14765 .html

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Law and Policy National Plan to Eliminate Syphilis from the United States: Executive Summary Source: National Center for HIV, STD, and TB Prevention http://www.cdc.gov/stopsyphilis/ExecSumPlan.htm

•

Organizations American Social Health Association http://www.ashastd.org/ National Center for HIV, STD, and TB Prevention, Division of Sexually Transmitted Diseases Source: Centers for Disease Control and Prevention http://www.cdc.gov/nchstp/dstd/dstdp.html National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/

•

Prevention/Screening Right Way to Use a Condom Source: American Social Health Association http://www.ashastd.org/stdfaqs/condom_a.html

•

Statistics FASTATS: Sexually Transmitted Disease Source: National Center for Health Statistics http://www.cdc.gov/nchs/fastats/stds.htm Syphilis among Infants Down More Than Half in Three Years Source: Centers for Disease Control and Prevention http://www.cdc.gov/od/oc/media/pressrel/r010712.htm Tracking the Hidden Epidemics 2000: Syphilis Source: National Center for HIV, STD, and TB Prevention http://www.cdc.gov/nchstp/od/news/RevBrochure1pdfSyphilis.htm U.S. Syphilis Rates Climb for Second Consecutive Year Source: Centers for Disease Control and Prevention http://www.cdc.gov/od/oc/media/pressrel/r031120.htm

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.

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The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on syphilis. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

What's It Going to Cost You? Syphilis Contact: Spence Research, Incorporated, Health Educo, 5045 Franklin Ave, Waco, TX, 76702, (817) 776-6461. Summary: This brochure for the general public discusses the sexually transmitted disease (STD), syphilis. Individuals who have any symptoms of syphilis should be tested by a healthcare provider immediately. The brochure identifies the symptoms of primary, secondary, and tertiary syphilis. Syphilis can be spread through oral, anal, or vaginal contact or through contact with an open lesion. Practicing sexual abstinence, monogamy, or safer sex with condoms can prevent syphilis. Individuals can further reduce their risk for contracting syphilis by avoiding substance abuse, which affects decision-making abilities. Syphilis is often treated by the drug benzathine penicillin. However, it is not always effective in persons with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). If syphilis is left untreated, it can cause meningitis, heart failure, brain and spinal cord damage, psychosis, dementia, and/or death. The brochure outlines the average costs for the treatment of syphilis. Contact information is provided for the Centers for Disease Control and Prevention's (CDC) National STD Hotline and for the American Social Health Association (ASHA).

•

STD: Sexually Transmitted Diseases - AIDS, Cervicitis, Chlamydia, Genital Warts, Gonorrhea, Herpes, PID, Syphilis, Urethritis, Vaginitis Contact: Intermedia, Incorporated, 1300 Dexter Ave, Seattle, WA, 98109, (206) 284-2995. Summary: This brochure presents general information about the warning signs and transmission of Sexually transmitted diseases (STD's) and their prevention and specific characteristics of the individual diseases in this group. Symptoms are not always present with STD's and the only way to know for sure is to have the right tests, and then the right treatment. The brochure contains a chart of the various STD's: Acquired immunodeficiency syndrome (AIDS), cervicitis, chlamydia, genital warts, gonorrhea, Herpes-virus group, pelvic inflammatory disease, syphilis, urethritis, and vaginitis, with pertinent information. For each disease it provides a definition, causative agent, mode of transmission, duration of infection, symptoms, diagnosis, treatment, and consequences if not treated. It lists steps to take when the presence of STD's is suspected.

•

Syphilis : What You Need to Know Contact: Education Programs Associates, Health Education Resource Center, 1 W Campbell Ave Ste 45, Campbell, CA, 95008, (408) 374-3720, http://www.cfhc.org. Summary: This brochure, for the general public, discusses the sexually transmitted disease (STD), syphilis. The first symptom of syphilis is a sore that does not hurt. Other symptoms include rash, fever, sore throat, joint pain, and loss of hair. Syphilis is treated with antibiotic shots or pills. Individuals with syphilis need to protect themselves by ensuring that partners are treated, taking all of the prescribed medication even if

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symptoms disappear, avoiding sex during treatment, reporting any drug side effects or new symptoms immediately to a health care provider, and undergoing follow-up treatment after the antibiotic regimen has been completed. If left untreated, syphilis can cause blindness, heart disease, brain damage, insanity, or death. Pregnant women with syphilis can infect their infants, which can lead to stillbirth or birth defects. When persons with syphilis have chancre sores, they are at a greater risk of catching the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). To help to prevent STDs, individuals should practice safer sex with condoms and foam during each sexual encounter. The brochure provides contact information for services from which individuals can learn more about syphilis. •

If You Are Pregnant or Think You Might Be Pregnant, You Need to Know About HIV. Pregnant? Protect Your Baby From Syphilis Contact: Texas Department of Health Warehouse, Attn: Literature and Forms, 1100 W 49th St, Austin, TX, 78756, (512) 458-7761. Summary: This fact sheet for women who want to become or who are pregnant provides information about the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and syphilis. It recommends that women be tested for HIV and describes the difference between a confidential and an anonymous test. Testing can help the mother because she can begin treatment and can help prevent the transmission of HIV to the baby before, during, and after birth. To avoid HIV infection, persons can practice sexual abstinence, stay in a monogamous relationship, use latex condoms during sex, and avoid drug use and needle sharing. The fact sheet describes syphilis, congenital syphilis, and the health risks associated with the latter. Syphilis can be cured. If the readers think they are exhibiting the symptoms of syphilis or any other sexually transmitted disease (STD) or if they believe they have practiced high-risk behaviors, they should be tested. The readers can prevent syphilis by practicing sexual abstinence, staying in a completely monogamous relationship, using condoms during all sexual activities, seeking prenatal care immediately upon learning they are pregnant, seeking treatment if they are experiencing symptoms of syphilis, undergoing treatment immediately if they test positive for syphilis, and getting tested early and late in pregnancy for syphilis.

•

What Is Syphilis? Contact: California Department of Health Services, Office of AIDS, California AIDS Clearinghouse, 1443 N Martel Ave, Los Angeles, CA, 90046-4207, (323) 845-4180, http://www.hivinfo.org/cac/cachouse.shtml. Summary: This fact sheet provides general information about syphilis, a sexually transmitted disease (STD). In the incubation stage of syphilis infection, there are no symptoms, and it may take as long as ninety days from exposure for a blood test to detect it. In the primary stage, a painless sore forms on the penis, vagina, anus, or mouth and goes away without treatment; glands in the groin area may swell; blood tests will detect syphilitic bacteria; and infected individuals are highly contagious. In the secondary stage of syphilis, individuals may get more sores and rashes, particularly around the hands and feet and can spread this STD easily. In the latent stage of syphilis, persons do not show any signs of the STD, will test positive for it, and may experience serious health problems as a result of not having been treated. If left untreated, syphilis can cause brain damage, heart disease, and other long-term health problems. Practicing safer sex with condoms and seeing a doctor regularly can help to prevent syphilis. Individuals with syphilis can be treated with an antibiotic injection. Patients will need a

150 Syphilis

repeat blood test one week after treatment and then every month until cured. They should tell their health care providers if they are pregnant, should inform their sex partners so they can get tested, and should avoid having sex until cured. The fact sheet provides contact information for services from which individuals can learn more about STDs and the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). •

Eliminating Syphilis : Baltimore City, Maryland Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for HIV STD and TB Prevention, 1600 Clifton Rd NE MS E06, Atlanta, GA, 30333, (404) 639-8063, http://www.cdc.gov/nchstp/od/nchstp.html. Summary: This fact sheet provides information concerning the elimination of syphilis in Baltimore City, MD. Syphilis elimination in the United States (US) is within reach now because (1) syphilis is preventable and curable; (2) infectious syphilis is at the lowest rate ever reported at 2.6 cases per 100,000 citizens or 6,993 cases; (3) syphilis is geographically concentrated with half of all new cases in 1998 reported from 28 counties, which represents less than 1% of all US counties; and (4) other industrialized countries have already eliminated syphilis. In 1998, Baltimore City ranked first in the nation in new cases of infectious syphilis (456 cases) and had a rate nearly 27 times higher than the national average. In Baltimore City, 96% of cases are among African Americans (versus 79% of national cases), and the infectious syphilis rate for African Americans is nearly 14 times greater than the rate for White Americans. Elimination of syphilis is important because syphilis increases HIV transmission at least 2-to-5 fold and can be transmitted from mother to fetus during pregnancy causing stillbirths or congenital syphilis. In 1998, 28 cases of congenital syphilis were reported from Baltimore City for a rate of 270 cases per 100,000 births, 13 times higher than the national rate. Baltimore City is responding through (1) the Syphilis Elimination Plan Working Group, composed of representatives from the affected community, state and city government, laboratories, correctional facilities, managed care organizations, and medical centers, which is responsible for creating and implementing the local syphilis elimination plan; (2) the Maryland Department of Health and Mental Hygiene's Stat testing program for syphilis in the Baltimore City Booking and Intake Center; and (3) follow-up on patients who test positive for syphilis provided by a Disease Intervention Specialist who works with Total Health Care, a Federally Qualified Health Center.

•

STD : Syphilis Contact: New York City Department of Health, Division of Public Health Promotion, 125 Worth St, New York, NY, 10013, (212) 788-4415. Summary: This information sheet presents general information about the sexually transmitted disease (STD), syphilis, including how it is transmitted, the symptoms of syphilis; at what stage these symptoms occur and the length of time before they appear in an infected person; how syphilis is diagnosed and treated, and how it can be prevented through safer sex with condoms.

•

STD Facts: Syphilis ('Syph', 'The Pox') (Caused by Treponema Pallidum, a Bacteria) Contact: Minnesota Department of Health, Infectious Disease Epidemiology Prevention and Control Division, PO Box 9441, Minneapolis, MN, 55440-9441, (612) 676-5414, http://www.health.state.mn.us/divs/dpc/idepc.html.

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Summary: This information sheet presents the signs and symptoms of first, second, and latent stage syphilis, a sexually transmitted disease caused by Treponema pallidum, a bacteria. It covers routes of transmission, health consequences and complications if left untreated, prevention, and the importance of proper treatment. The information sheet includes sources of additional information. •

Syphilis Contact: Kansas Department of Health and Environment, Bureau of Epidemiology and Disease Prevention, HIV-STD Section, 1000 SW Jackson Ste 210, Topeka, KS, 66612-1274, (785) 296-6173, http://www.kdhe.state.ks.us/olrh/download/health_directory.pdf. Summary: This information sheet provides facts about the sexually transmitted disease (STD), syphilis. It discusses its transmission; symptoms of primary, second stage, latent, and tertiary syphilis; medical treatments available; and risks associated with syphilis transmission during pregnancy. Recommendations for individuals undergoing treatment are provided.

•

What You Should Know About Syphilis Contact: Texas Department of Health Warehouse, Attn: Literature and Forms, 1100 W 49th St, Austin, TX, 78756, (512) 458-7761. Summary: This pamphlet discusses syphilis, its symptoms, testing, its effect on pregnancy, the increased risk of infection with the human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), and treatment.

•

Syphilis : A Serious Disease : A Simple Cure Contact: CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 458-5231, http://www.cdcnpin.org. Summary: This pamphlet provides information about syphilis, a sexually transmitted disease (STD). The pamphlet describes the initial symptoms of syphilis as well as the later symptoms such as mental illness, blindness, or heart disease. Syphilis increases an individual's risks for contracting the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and can lead to death. Syphilis can be spread from a mother to her child during pregnancy. Pregnant women are advised to get tested and, if they are infected, they should begin treatment right away. While syphilis is easy to treat, it is also possible to contract it more than once. To prevent or reduce the risks of contracting syphilis, individuals should practice sexual abstinence, monogamy, and/or safer sex with condoms, and get regular check-ups. The pamphlet provides phone numbers that individuals can use to learn more about syphilis.

•

Syphilis Card Contact: North Carolina Department of Environment, Health, and, Natural Resources, HIV/STD Control Branch, PO Box 27687, Raleigh, NC, 27611-7687, (919) 733-7301. Summary: This wallet card describes syphilis, its symptoms, its treatment, and its relationship to HIV/AIDS. It also discusses testing for syphilis, HIV, and pregnancy. It gives toll-free hotline telephone numbers.

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The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “syphilis” (or synonyms). The following was recently posted: •

2002 national guidelines for the management of late syphilis Source: Association for Genitourinary Medicine - Medical Specialty Society; 1999 August (revised 2002); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3037&nbr=2263&a mp;string=syphilis

•

2002 national guidelines on the management of early syphilis Source: Association for Genitourinary Medicine - Medical Specialty Society; 1999 August (revised 2002); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3036&nbr=2262&a mp;string=syphilis

•

Clinical standards for the screening and management of acquired syphilis in HIVpositive adults Source: Medical Society for the Study of Venereal Diseases - Disease Specific Society; 2002 February; 9 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3440&nbr=2666&a mp;string=syphilis

•

Congenital syphilis. Sexually transmitted diseases treatment guidelines 2002 Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1993 (revised 2002 May 10); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3234&nbr=2460&a mp;string=syphilis

•

Syphilis Source: Finnish Medical Society Duodecim - Professional Association; 2001 November 22; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3396&nbr=2622&a mp;string=syphilis Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database:

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Syphilis Summary: Syphilis, once a cause of devastating epidemics, now can be effectively controlled with antibiotic therapy. Yet, in many cities of the United States both adult and congenital syphilis are on the rise. Source: National Institute of Allergy and Infectious Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=176 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to syphilis. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

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Med Help International: http://www.medhelp.org/HealthTopics/A.html

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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

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WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to syphilis. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with syphilis.

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The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about syphilis. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “syphilis” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “syphilis”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “syphilis” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “syphilis” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.23

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

23

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)24: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

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California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

24

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on syphilis: •

Basic Guidelines for Syphilis Congenital syphilis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001344.htm Pid Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000888.htm Syphilis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001327.htm Syphilis - primary Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000861.htm Syphilis - secondary Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000854.htm Syphilis - tertiary Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000662.htm

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•

Signs & Symptoms for Syphilis Aches and pains in bones Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003180.htm Alopecia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003246.htm Arthralgia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003261.htm Bleeding between periods Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003156.htm Chills Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003091.htm Enlarged lymph nodes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003097.htm Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Genital lesions (female) Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003222.htm Genital lesions (male) Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003221.htm Glands, swollen Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003097.htm Groin lump Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003100.htm Hair loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003246.htm Headache Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003024.htm Hearing loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003044.htm Hepatosplenomegaly Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003275.htm Jaundice Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003243.htm

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Joint aches Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003261.htm Limited range of motion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003173.htm Loss of appetite Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003121.htm Malaise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003089.htm Mouth sores Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003059.htm Muscle Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Muscle aches Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003178.htm Myalgia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003178.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Nosebleed - symptom Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003106.htm Papule Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003233.htm Paralysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003190.htm Patches Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003231.htm Rash Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Skin lesion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Skin lesions Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Skin rash Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm

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Swallowing difficulty Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003115.htm Vaginal bleeding between periods Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003156.htm •

Diagnostics and Tests for Syphilis ALT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003473.htm Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm Donath-Landsteiner test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003668.htm ESR Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm Febrile/cold agglutinins Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003549.htm FTA-ABS Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003512.htm FTA-ABS (fluorescent treponemal antibody test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003512.htm FTA-ABS fluorescent treponemal antibody test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003512.htm Gumma Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000859.htm Immunofluorescence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003521.htm Lumbar puncture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003428.htm Rapid plasma reagin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003533.htm RPR Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003533.htm Serology Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003511.htm Skin biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003840.htm

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Spinal fluid examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003768.htm STS Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003512.htm Ulcer Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003225.htm Ulcers Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003228.htm VDRL Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003515.htm •

Background Topics for Syphilis Benign Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002236.htm Cardiovascular Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002310.htm Central nervous system Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002311.htm Cervix Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002317.htm Condoms Web site: http://www.nlm.nih.gov/medlineplus/ency/article/004001.htm Heart disease Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000147.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm Penis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002279.htm Reportable disease Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001929.htm Safer sexual practices Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001949.htm Symptomatic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002293.htm Systemic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002294.htm

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Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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SYPHILIS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abscess: A localized, circumscribed collection of pus. [NIH] Acetone: A colorless liquid used as a solvent and an antiseptic. It is one of the ketone bodies produced during ketoacidosis. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Acquired Immunodeficiency Syndrome: An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive Tlymphocyte count under 200 cells/microliter or less than 14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as defined by the CDC in 1993. [NIH] Acyclovir: Functional analog of the nucleoside guanosine. It acts as an antimetabolite, especially in viruses. It is used as an antiviral agent, especially in herpes infections. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adsorption: The condensation of gases, liquids, or dissolved substances on the surfaces of solids. It includes adsorptive phenomena of bacteria and viruses as well as of tissues treated with exogenous drugs and chemicals. [NIH] Adsorptive: It captures volatile compounds by binding them to agents such as activated carbon or adsorptive resins. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Affinity Chromatography: In affinity chromatography, a ligand attached to a column binds specifically to the molecule to be purified. [NIH]

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Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Agarose: A polysaccharide complex, free of nitrogen and prepared from agar-agar which is produced by certain seaweeds (red algae). It dissolves in warm water to form a viscid solution. [NIH] Agglutinins: Substances, usually of biological origin, that cause cells or other organic particles to aggregate and stick to each other. They also include those antibodies which cause aggregation or agglutination of a particulate or insoluble antigen. [NIH] Aggressiveness: The quality of being aggressive (= characterized by aggression; militant; enterprising; spreading with vigour; chemically active; variable and adaptable). [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alienation: Disruption of feeling of belonging to a larger group such as, for example, the deepening of the generation gap or increasing of a gulf separating social groups from one another. In a more limited sense breaking down of a close relationship. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alum: A type of immune adjuvant (a substance used to help boost the immune response to a vaccine). Also called aluminum sulfate. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amphetamines: Analogs or derivatives of amphetamine. Many are sympathomimetics and central nervous system stimulators causing excitation, vasopression, bronchodilation, and to varying degrees, anorexia, analepsis, nasal decongestion, and some smooth muscle relaxation. [NIH] Amplification: The production of additional copies of a chromosomal DNA sequence,

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found as either intrachromosomal or extrachromosomal DNA. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH]

Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]

Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibodies, Anticardiolipin: Antiphospholipid antibodies found in association with systemic lupus erythematosus (lupus erythematosus, systemic), antiphospholipid syndrome, and in a variety of other diseases as well as in healthy individuals. The antibodies are detected by solid-phase immunoassay employing the purified phospholipid antigen cardiolipin. [NIH] Antibodies, Antiphospholipid: Autoantibodies directed against phospholipids. These antibodies are characteristically found in patients with systemic lupus erythematosus, antiphospholipid syndrome, related autoimmune diseases, some non-autoimmune diseases, and also in healthy individuals. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH]

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Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antigen-presenting cell: APC. A cell that shows antigen on its surface to other cells of the immune system. This is an important part of an immune response. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antiphospholipid Syndrome: The presence of antibodies directed against phospholipids (antibodies, antiphospholipid). The condition is associated with a variety of diseases, notably systemic lupus erythematosus and other connective tissue diseases, thrombopenia, and arterial or venous thromboses. In pregnancy it can cause abortion. Of the phospholipids, the cardiolipins show markedly elevated levels of anticardiolipin antibodies (antibodies, anticardiolipin). Present also are high levels of lupus anticoagulant (lupus coagulation inhibitor). [NIH] Antiseptic: A substance that inhibits the growth and development of microorganisms without necessarily killing them. [EU] Antiserum: The blood serum obtained from an animal after it has been immunized with a particular antigen. It will contain antibodies which are specific for that antigen as well as antibodies specific for any other antigen with which the animal has previously been immunized. [NIH] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH]

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Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriolar: Pertaining to or resembling arterioles. [EU] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Artifacts: Any visible result of a procedure which is caused by the procedure itself and not by the entity being analyzed. Common examples include histological structures introduced by tissue processing, radiographic images of structures that are not naturally present in living tissue, and products of chemical reactions that occur during analysis. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Astringents: Agents, usually topical, that cause the contraction of tissues for the control of bleeding or secretions. [NIH] Astrocytes: The largest and most numerous neuroglial cells in the brain and spinal cord. Astrocytes (from "star" cells) are irregularly shaped with many long processes, including those with "end feet" which form the glial (limiting) membrane and directly and indirectly contribute to the blood brain barrier. They regulate the extracellular ionic and chemical environment, and "reactive astrocytes" (along with microglia) respond to injury. Astrocytes have high- affinity transmitter uptake systems, voltage-dependent and transmitter-gated ion channels, and can release transmitter, but their role in signaling (as in many other functions) is not well understood. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Attenuated: Strain with weakened or reduced virulence. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Autacoids: A chemically diverse group of substances produced by various tissues in the body that cause slow contraction of smooth muscle; they have other intense but varied pharmacologic activities. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls,

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multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bilateral: Affecting both the right and left side of body. [NIH] Binding Sites: The reactive parts of a macromolecule that directly participate in its specific combination with another molecule. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biochemical reactions: In living cells, chemical reactions that help sustain life and allow cells to grow. [NIH] Biological response modifier: BRM. A substance that stimulates the body's response to infection and disease. [NIH] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotype: A group of individuals having the same genotype. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH]

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Blennorrhoea: A general term including any inflammatory process of the external eye which gives a mucoid discharge, more exactly, a discharge of mucus. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blot: To transfer DNA, RNA, or proteins to an immobilizing matrix such as nitrocellulose. [NIH]

Blotting, Western: Identification of proteins or peptides that have been electrophoretically separated by blotting and transferred to strips of nitrocellulose paper. The blots are then detected by radiolabeled antibody probes. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone Cements: Adhesives used to fix prosthetic devices to bones and to cement bone to bone in difficult fractures. Synthetic resins are commonly used as cements. A mixture of monocalcium phosphate, monohydrate, alpha-tricalcium phosphate, and calcium carbonate with a sodium phosphate solution is also a useful bone paste. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Buffaloes: Ruminants of the family Bovidae consisting of Bubalus arnee and Syncerus caffer. This concept is differentiated from bison, which refers to Bison bison and Bison bonasus. [NIH] Bupropion: A unicyclic, aminoketone antidepressant. The mechanism of its therapeutic actions is not well understood, but it does appear to block dopamine uptake. The hydrochloride is available as an aid to smoking cessation treatment. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH]

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Canonical: A particular nucleotide sequence in which each position represents the base more often found when many actual sequences of a given class of genetic elements are compared. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Cefmetazole: A semisynthetic cephamycin antibiotic with a broad spectrum of activity against both gram-positive and gram-negative microorganisms. It has a high rate of efficacy in many types of infection and to date no severe side effects have been noted. [NIH] Ceftriaxone: Broad-spectrum cephalosporin antibiotic with a very long half-life and high penetrability to usually inaccessible infections, including those involving the meninges, eyes, inner ears, and urinary tract. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell Movement: The movement of cells from one location to another. [NIH] Central Nervous System: The main information-processing organs of the nervous system,

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consisting of the brain, spinal cord, and meninges. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Chancre: The primary sore of syphilis, a painless indurated, eroded papule, occurring at the site of entry of the infection. [NIH] Check-up: A general physical examination. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotaxis: The movement of cells or organisms toward or away from a substance in response to its concentration gradient. [NIH] Chlamydia: A genus of the family Chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is Chlamydia trachomatis. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Choriocarcinoma: A malignant tumor of trophoblastic epithelium characterized by secretion of large amounts of chorionic gonadotropin. It usually originates from chorionic products of conception (i.e., hydatidiform mole, normal pregnancy, or following abortion), but can originate in a teratoma of the testis, mediastinum, or pineal gland. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public,

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interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Clear cell carcinoma: A rare type of tumor of the female genital tract in which the inside of the cells looks clear when viewed under a microscope. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Cochlear Nerve: The cochlear part of the 8th cranial nerve (vestibulocochlear nerve). The cochlear nerve fibers originate from neurons of the spiral ganglion and project peripherally to cochlear hair cells and centrally to the cochlear nuclei (cochlear nucleus) of the brain stem. They mediate the sense of hearing. [NIH] Cochlear Nucleus: The brain stem nucleus that receives the central input from the cochlear nerve. The cochlear nucleus is located lateral and dorsolateral to the inferior cerebellar peduncles and is functionally divided into dorsal and ventral parts. It is tonotopically organized, performs the first stage of central auditory processing, and projects (directly or indirectly) to higher auditory areas including the superior olivary nuclei, the medial geniculi, the inferior colliculi, and the auditory cortex. [NIH] Codon: A set of three nucleotides in a protein coding sequence that specifies individual amino acids or a termination signal (codon, terminator). Most codons are universal, but some organisms do not produce the transfer RNAs (RNA, transfer) complementary to all codons. These codons are referred to as unassigned codons (codons, nonsense). [NIH]

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Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colloidal: Of the nature of a colloid. [EU] Communicable disease: A disease that can be transmitted by contact between persons. [NIH] Communicable Disease Control: Programs of surveillance designed to prevent the transmission of disease by any means from person to person or from animal to man. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such

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as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Congenita: Displacement, subluxation, or malposition of the crystalline lens. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Diseases: A heterogeneous group of disorders, some hereditary, others acquired, characterized by abnormal structure or function of one or more of the elements of connective tissue, i.e., collagen, elastin, or the mucopolysaccharides. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contact Tracing: Identification of those persons (or animals) who have had such an association with an infected person, animal, or contaminated environment as to have had the opportunity to acquire the infection. Contact tracing is a generally accepted method for the control of sexually transmitted diseases. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU]

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Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Corneum: The superficial layer of the epidermis containing keratinized cells. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cost-benefit: A quantitative technique of economic analysis which, when applied to radiation practice, compares the health detriment from the radiation doses concerned with the cost of radiation dose reduction in that practice. [NIH] Crack Cocaine: The purified, alkaloidal, extra-potent form of cocaine. It is smoked (freebased), injected intravenously, and orally ingested. Use of crack results in alterations in function of the cardiovascular system, the autonomic nervous system, the central nervous system, and the gastrointestinal system. The slang term "crack" was derived from the crackling sound made upon igniting of this form of cocaine for smoking. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Crossing-over: The exchange of corresponding segments between chromatids of homologous chromosomes during meiosia, forming a chiasma. [NIH] Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan, Cryptosporidium. It occurs in both animals and humans. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Data Collection: Systematic gathering of data for a particular purpose from various sources,

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including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites. [EU] Dendritic cell: A special type of antigen-presenting cell (APC) that activates T lymphocytes. [NIH]

Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] Dermatitis: Any inflammation of the skin. [NIH] DES: Diethylstilbestrol. A synthetic hormone that was prescribed from the early 1940s until 1971 to help women with complications of pregnancy. DES has been linked to an increased risk of clear cell carcinoma of the vagina in daughters of women who used DES. DES may also increase the risk of breast cancer in women who used DES. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH]

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Diagnostic Errors: Incorrect diagnoses after clinical examination or technical diagnostic procedures. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disease Transmission: The transmission of infectious disease or pathogens. When transmission is within the same species, the mode can be horizontal (disease transmission, horizontal) or vertical (disease transmission, vertical). [NIH] Disease Transmission, Horizontal: The transmission of infectious disease or pathogens from one individual to another in the same generation. [NIH] Disease Transmission, Vertical: The transmission of infectious disease or pathogens from one generation to another. It includes transmission in utero or intrapartum by exposure to blood and secretions, and postpartum exposure via breastfeeding. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Domesticated: Species in which the evolutionary process has been influenced by humans to meet their needs. [NIH]

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Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Douching: A jet or current of water, sometimes a dissolved medicating or cleansing agent, applied to a body part, organ or cavity for medicinal or hygienic purposes. [EU] Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Resistance: Diminished or failed response of an organism, disease or tissue to the intended effectiveness of a chemical or drug. It should be differentiated from drug tolerance which is the progressive diminution of the susceptibility of a human or animal to the effects of a drug, as a result of continued administration. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dysentery: Any of various disorders marked by inflammation of the intestines, especially of the colon, and attended by pain in the abdomen, tenesmus, and frequent stools containing blood and mucus. Causes include chemical irritants, bacteria, protozoa, or parasitic worms. [EU]

Ectopic: Pertaining to or characterized by ectopia. [EU] Ectopic Pregnancy: The pregnancy occurring elsewhere than in the cavity of the uterus. [NIH]

Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the

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latter being a high-energy biproduct of nuclear decay. [NIH] Emaciation: Clinical manifestation of excessive leanness usually caused by disease or a lack of nutrition. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Encephalitis: Inflammation of the brain due to infection, autoimmune processes, toxins, and other conditions. Viral infections (see encephalitis, viral) are a relatively frequent cause of this condition. [NIH] Encephalitis, Viral: Inflammation of brain parenchymal tissue as a result of viral infection. Encephalitis may occur as primary or secondary manifestation of Togaviridae infections; Herpesviridae infections; Adenoviridae infections; Flaviviridae infections; Bunyaviridae infections; Picornaviridae infections; Paramyxoviridae infections; Orthomyxoviridae infections; Retroviridae infections; and Arenaviridae infections. [NIH] Encephalopathy: A disorder of the brain that can be caused by disease, injury, drugs, or chemicals. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health.

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[NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme-Linked Immunosorbent Assay: An immunoassay utilizing an antibody labeled with an enzyme marker such as horseradish peroxidase. While either the enzyme or the antibody is bound to an immunosorbent substrate, they both retain their biologic activity; the change in enzyme activity as a result of the enzyme-antibody-antigen reaction is proportional to the concentration of the antigen and can be measured spectrophotometrically or with the naked eye. Many variations of the method have been developed. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epithalamus: The dorsal posterior subdivision of the diencephalon. The epithalamus is generally considered to include the habenular nuclei (habenula) and associated fiber bundles, the pineal body, and the epithelial roof of the third ventricle. The anterior and posterior paraventricular nuclei of the thalamus are included with the thalamic nuclei although they develop from the same pronuclear mass as the epithalamic nuclei and are sometimes considered part of the epithalamus. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical

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disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Facial: Of or pertaining to the face. [EU] False Positive Reactions: Area that the program rates as suspicious but that the radiologist ultimately decides does not represent a possible malignancy. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibrinolytic: Pertaining to, characterized by, or causing the dissolution of fibrin by enzymatic action [EU] Fibronectin: An adhesive glycoprotein. One form circulates in plasma, acting as an opsonin; another is a cell-surface protein which mediates cellular adhesive interactions. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but

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distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flagellin: A protein with a molecular weight of 40,000 isolated from bacterial flagella. At appropriate pH and salt concentration, three flagellin monomers can spontaneously reaggregate to form structures which appear identical to intact flagella. [NIH] Flagellum: A whiplike appendage of a cell. It can function either as an organ of locomotion or as a device for moving the fluid surrounding the cell. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

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Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic Counseling: Advising families of the risks involved pertaining to birth defects, in order that they may make an informed decision on current or future pregnancies. [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genomics: The systematic study of the complete DNA sequences (genome) of organisms. [NIH]

Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geographic Locations: All of the continents and every country situated within, the United States and each of the constituent states arranged by region, Canada and each of its provinces, Australia and each of its states, the major bodies of water and major islands on both hemispheres, and selected major cities. Although the geographic locations are not printed in index medicus as main headings, in indexing they are significant in epidemiologic studies and historical articles and for locating administrative units in education and the delivery of health care. [NIH] Germanium: A rare metal element with a blue-gray appearance and atomic symbol Ge, atomic number 32, and atomic weight 72.59. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational trophoblastic disease: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic tumor, gestational trophoblastic neoplasia, molar pregnancy, or choriocarcinoma. [NIH] Gestational trophoblastic neoplasia: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic tumor, molar pregnancy, or choriocarcinoma. [NIH] Gestational trophoblastic tumor: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic neoplasia, molar pregnancy, or choriocarcinoma. [NIH] Giant Cells: Multinucleated masses produced by the fusion of many cells; often associated with viral infections. In AIDS, they are induced when the envelope glycoprotein of the HIV

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virus binds to the CD4 antigen of uninfected neighboring T4 cells. The resulting syncytium leads to cell death and thus may account for the cytopathic effect of the virus. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Gliosis: The production of a dense fibrous network of neuroglia; includes astrocytosis, which is a proliferation of astrocytes in the area of a degenerative lesion. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycerophospholipids: Derivatives of phosphatidic acid in which the hydrophobic regions are composed of two fatty acids and a polar alcohol is joined to the C-3 position of glycerol through a phosphodiester bond. They are named according to their polar head groups, such as phosphatidylcholine and phosphatidylethanolamine. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, Neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Gonorrhoea: Infection due to Neisseria gonorrhoeae transmitted sexually in most cases, but also by contact with infected exudates in neonatal children at birth, or by infants in households with infected inhabitants. It is marked in males by urethritis with pain and purulent discharge, but is commonly asymptomatic in females, although it may extend to produce suppurative salpingitis, oophoritis, tubo-ovarian abscess, and peritonitis. Bacteraemia occurs in both sexes, resulting in cutaneous lesions, arthritis, and rarely meningitis or endocarditis. Formerly called blennorrhagia and blennorrhoea. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Government Agencies: Administrative units of government responsible for policy making and management of governmental activities in the U.S. and abroad. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-Negative Bacteria: Bacteria which lose crystal violet stain but are stained pink when treated by Gram's method. [NIH] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method

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of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Granuloma Annulare: Benign granulomatous disease of unknown etiology characterized by a ring of localized or disseminated papules or nodules on the skin and palisading histiocytes surrounding necrobiotic tissue resulting from altered collagen structures. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guinea Pigs: A common name used for the family Caviidae. The most common species is Cavia porcellus which is the domesticated guinea pig used for pets and biomedical research. [NIH]

Gyrus Cinguli: One of the convolutions on the medial surface of the cerebral hemisphere. It surrounds the rostral part of the brain and interhemispheric commissure and forms part of the limbic system. [NIH] Haematoma: A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. [EU] Haemodialysis: The removal of certain elements from the blood by virtue of the difference in the rates of their diffusion through a semipermeable membrane, e.g., by means of a haemodialyzer. [EU] Haemorrhage: The escape of blood from the vessels; bleeding. Small haemorrhages are classified according to size as petechiae (very small), purpura (up to 1 cm), and ecchymoses (larger). The massive accumulation of blood within a tissue is called a haematoma. [EU] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH]

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Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Simplex Encephalitis: An inflammatory disease of the skin or mucous membrane characterized by the formation of clusters of small vesicles. [NIH] Herpes Zoster: Acute vesicular inflammation. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Hippocampus: A curved elevation of gray matter extending the entire length of the floor of the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Horny layer: The superficial layer of the epidermis containing keratinized cells. [NIH] Horseradish Peroxidase: An enzyme isolated from horseradish which is able to act as an antigen. It is frequently used as a histochemical tracer for light and electron microscopy. Its antigenicity has permitted its use as a combined antigen and marker in experimental immunology. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Human papillomavirus: HPV. A virus that causes abnormal tissue growth (warts) and is often associated with some types of cancer. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless,

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odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hypercapnia: A clinical manifestation of abnormal increase in the amount of carbon dioxide in arterial blood. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypodermic: Applied or administered beneath the skin. [EU] Hypomania: An abnormality of mood resembling mania (persistent elevated or expansive mood, hyperactivity, inflated self-esteem, etc.) but of lesser intensity. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Immune adjuvant: A drug that stimulates the immune system to respond to disease. [NIH] Immune Complex Diseases: Group of diseases mediated by the deposition of large soluble complexes of antigen and antibody with resultant damage to tissue. Besides serum sickness and the arthus reaction, evidence supports a pathogenic role for immune complexes in many other systemic immunologic diseases including glomerulonephritis, systemic lupus erythematosus and polyarteritis nodosa. [NIH] Immune function: Production and action of cells that fight disease or infection. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or

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immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunoblotting: Immunologic methods for isolating and quantitatively measuring immunoreactive substances. When used with immune reagents such as monoclonal antibodies, the process is known generically as western blot analysis (blotting, western). [NIH]

Immunocompromised: Having a weakened immune system caused by certain diseases or treatments. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]

Immunofluorescence: A technique for identifying molecules present on the surfaces of cells or in tissues using a highly fluorescent substance coupled to a specific antibody. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indomethacin: A non-steroidal anti-inflammatory agent (NSAID) that inhibits the enzyme cyclooxygenase necessary for the formation of prostaglandins and other autacoids. It also inhibits the motility of polymorphonuclear leukocytes. [NIH] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

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Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Informed Consent: Voluntary authorization, given to the physician by the patient, with full comprehension of the risks involved, for diagnostic or investigative procedures and medical and surgical treatment. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Insertional: A technique in which foreign DNA is cloned into a restriction site which occupies a position within the coding sequence of a gene in the cloning vector molecule. Insertion interrupts the gene's sequence such that its original function is no longer expressed. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interpersonal Relations: The reciprocal interaction of two or more persons. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervention Studies: Epidemiologic investigations designed to test a hypothesized causeeffect relation by modifying the supposed causal factor(s) in the study population. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intracellular: Inside a cell. [NIH] Intracellular Membranes: Membranes of subcellular structures. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intramuscular injection: IM. Injection into a muscle. [NIH] Intravenous: IV. Into a vein. [NIH]

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Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Isotonic: A biological term denoting a solution in which body cells can be bathed without a net flow of water across the semipermeable cell membrane. Also, denoting a solution having the same tonicity as some other solution with which it is compared, such as physiologic salt solution and the blood serum. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratitis: Inflammation of the cornea. [NIH] Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [NIH] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH]

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Lectin: A complex molecule that has both protein and sugars. Lectins are able to bind to the outside of a cell and cause biochemical changes in it. Lectins are made by both animals and plants. [NIH] Leishmaniasis: A disease caused by any of a number of species of protozoa in the genus Leishmania. There are four major clinical types of this infection: cutaneous (Old and New World), diffuse cutaneous, mucocutaneous, and visceral leishmaniasis. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Leptospirosis: Infections with bacteria of the genus Leptospira. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukoplakia: A white patch that may develop on mucous membranes such as the cheek, gums, or tongue and may become cancerous. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Limbic: Pertaining to a limbus, or margin; forming a border around. [EU] Limbic System: A set of forebrain structures common to all mammals that is defined functionally and anatomically. It is implicated in the higher integration of visceral, olfactory, and somatic information as well as homeostatic responses including fundamental survival behaviors (feeding, mating, emotion). For most authors, it includes the amygdala, epithalamus, gyrus cinguli, hippocampal formation (see hippocampus), hypothalamus, parahippocampal gyrus, septal nuclei, anterior nuclear group of thalamus, and portions of the basal ganglia. (Parent, Carpenter's Human Neuroanatomy, 9th ed, p744; NeuroNames, http://rprcsgi.rprc.washington.edu/neuronames/index.html (September 2, 1998)). [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipopolysaccharide: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood

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and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumbar puncture: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a spinal tap. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocyte Count: A count of the number of lymphocytes in the blood. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU]

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Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malaria: A protozoan disease caused in humans by four species of the genus Plasmodium (P. falciparum (malaria, falciparum), P. vivax (malaria, vivax), P. ovale, and P. malariae) and transmitted by the bite of an infected female mosquito of the genus Anopheles. Malaria is endemic in parts of Asia, Africa, Central and South America, Oceania, and certain Caribbean islands. It is characterized by extreme exhaustion associated with paroxysms of high fever, sweating, shaking chills, and anemia. Malaria in animals is caused by other species of plasmodia. [NIH] Malaria, Falciparum: Malaria caused by Plasmodium falciparum. This is the severest form of malaria and is associated with the highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms that in extreme cases occur with acute cerebral, renal, or gastrointestinal manifestations. [NIH] Malaria, Vivax: Malaria caused by Plasmodium vivax. This form of malaria is less severe than malaria, falciparum, but there is a higher probability for relapses to occur. Febrile paroxysms often occur every other day. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mania: Excitement of psychotic proportions manifested by mental and physical hyperactivity, disorganization of behaviour, and elevation of mood. [EU] Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] Marital Status: A demographic parameter indicating a person's status with respect to marriage, divorce, widowhood, singleness, etc. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into

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immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mercury: A silver metallic element that exists as a liquid at room temperature. It has the atomic symbol Hg (from hydrargyrum, liquid silver), atomic number 80, and atomic weight 200.59. Mercury is used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents. It can be absorbed through the skin and mucous membranes which leads to mercury poisoning. Because of its toxicity, the clinical use of mercury and mercurials is diminishing. [NIH] Methamphetamine: A central nervous system stimulant and sympathomimetic with actions and uses similar to dextroamphetamine. The smokable form is a drug of abuse and is referred to as crank, crystal, crystal meth, ice, and speed. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Mice Minute Virus: The type species of parvovirus prevalent in mouse colonies and found as a contaminant of many transplanted tumors or leukemias. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Migrans: Infestation of the dermis by various larvae, characterized by bizarre red irregular lines which are broad at one end and fade at the other, produced by burrowing larvae. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Mode of Transmission: Hepatitis A [NIH] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Molar pregnancy: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic neoplasia, gestational trophoblastic tumor, or choriocarcinoma. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA,

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can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monoclonal antibodies: Laboratory-produced substances that can locate and bind to cancer cells wherever they are in the body. Many monoclonal antibodies are used in cancer detection or therapy; each one recognizes a different protein on certain cancer cells. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to a tumor. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Mucocutaneous: Pertaining to or affecting the mucous membrane and the skin. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multivalent: Pertaining to a group of 5 or more homologous or partly homologous chromosomes during the zygotene stage of prophase to first metaphasis in meiosis. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mutagens: Chemical agents that increase the rate of genetic mutation by interfering with the function of nucleic acids. A clastogen is a specific mutagen that causes breaks in chromosomes. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myoclonus: Involuntary shock-like contractions, irregular in rhythm and amplitude, followed by relaxation, of a muscle or a group of muscles. This condition may be a feature of some central nervous systems diseases (e.g., epilepsy, myoclonic). Nocturnal myoclonus may represent a normal physiologic event or occur as the principal feature of the nocturnal myoclonus syndrome. (From Adams et al., Principles of Neurology, 6th ed, pp102-3). [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH]

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Needle Sharing: Usage of a single needle among two or more people for injecting drugs. Needle sharing is a high-risk behavior for contracting infectious disease. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neuroglia: The non-neuronal cells of the nervous system. They are divided into macroglia (astrocytes, oligodendroglia, and schwann cells) and microglia. They not only provide physical support, but also respond to injury, regulate the ionic and chemical composition of the extracellular milieu, participate in the blood-brain and blood-retina barriers, form the myelin insulation of nervous pathways, guide neuronal migration during development, and exchange metabolites with neurons. Neuroglia have high-affinity transmitter uptake systems, voltage-dependent and transmitter-gated ion channels, and can release transmitters, but their role in signaling (as in many other functions) is unclear. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neurosyphilis: A late form of syphilis that affects the brain and may lead to dementia and death. [NIH] Nickel: A trace element with the atomic symbol Ni, atomic number 28, and atomic weight 58.69. It is a cofactor of the enzyme urease. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other

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characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Oncogenic: Chemical, viral, radioactive or other agent that causes cancer; carcinogenic. [NIH] Oophoritis: Inflammation of an ovary. [NIH] Open Reading Frames: Reading frames where successive nucleotide triplets can be read as codons specifying amino acids and where the sequence of these triplets is not interrupted by stop codons. [NIH] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [NIH] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Orthostatic: Pertaining to or caused by standing erect. [EU] Ossification: The formation of bone or of a bony substance; the conversion of fibrous tissue or of cartilage into bone or a bony substance. [EU] Otolaryngologist: A doctor who specializes in treating diseases of the ear, nose, and throat. Also called an ENT doctor. [NIH] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Otology: The branch of medicine which deals with the diagnosis and treatment of the disorders and diseases of the ear. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate

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and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papillomavirus: A genus of Papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH] Papule: A small circumscribed, superficial, solid elevation of the skin. [EU] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and phosphorus. [NIH] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Parotid: The space that contains the parotid gland, the facial nerve, the external carotid artery, and the retromandibular vein. [NIH] Particle: A tiny mass of material. [EU] Parvovirus: A genus of the family Parvoviridae, subfamily Parvovirinae, infecting a variety of vertebrates including humans. Parvoviruses are responsible for a number of important diseases but also can be non-pathogenic in certain hosts. The type species is mice minute virus. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogen: Any disease-producing microorganism. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pelvic: Pertaining to the pelvis. [EU] Pelvic inflammatory disease: A bacteriological disease sometimes associated with intrauterine device (IUD) usage. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH]

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Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Pentamidine: Antiprotozoal agent effective in trypanosomiasis, leishmaniasis, and some fungal infections; used in treatment of Pneumocystis carinii pneumonia in HIV-infected patients. It may cause diabetes mellitus, central nervous system damage, and other toxic effects. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]

Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Petechiae: Pinpoint, unraised, round red spots under the skin caused by bleeding. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Phallic: Pertaining to the phallus, or penis. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phosphodiesterase: Effector enzyme that regulates the levels of a second messenger, the cyclic GMP. [NIH]

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Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pinta: An infectious disease of the skin caused by Treponema carateum that occurs only in the western hemisphere. Age of onset is between 10 and 20 years of age. This condition is characterized by marked changes in the skin color and is believed to be transmitted by direct person-to-person contact. [NIH] Plague: An acute infectious disease caused by Yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different

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stages of development. [EU] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Population Growth: Increase, over a specific period of time, in the number of individuals living in a country or region. [NIH] Porins: Protein molecules situated in the outer membrane of gram-negative bacteria that, in dimeric or trimeric form, constitute a water-filled transmembrane channel allowing passage of ions and other small molecules. Porins are also found in bacterial cell walls, and in plant, fungal, mammalian and other vertebrate cell and mitochondrial membranes. [NIH] Porosity: Condition of having pores or open spaces. This often refers to bones, bone implants, or bone cements, but can refer to the porous state of any solid substance. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prenatal Care: Care provided the pregnant woman in order to prevent complications, and decrease the incidence of maternal and prenatal mortality. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Prognostic factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease, or the chance of the disease recurring (coming back). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or

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severity. [EU] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Conformation: The characteristic 3-dimensional shape of a protein, including the secondary, supersecondary (motifs), tertiary (domains) and quaternary structure of the peptide chain. Quaternary protein structure describes the conformation assumed by multimeric proteins (aggregates of more than one polypeptide chain). [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH]

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Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]

Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Embolism: Embolism in the pulmonary artery or one of its branches. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pupil: The aperture in the iris through which light passes. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis,

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caused by hemorrhage into the tissues. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radioimmunoassay: Classic quantitative assay for detection of antigen-antibody reactions using a radioactively labeled substance (radioligand) either directly or indirectly to measure the binding of the unlabeled substance to a specific antibody or other receptor system. Nonimmunogenic substances (e.g., haptens) can be measured if coupled to larger carrier proteins (e.g., bovine gamma-globulin or human serum albumin) capable of inducing antibody formation. [NIH] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy. [NIH]

Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Reactivation: The restoration of activity to something that has been inactivated. [EU] Reading Frames: The sequence of codons by which translation may occur. A segment of mRNA 5'AUCCGA3' could be translated in three reading frames, 5'AUC. or 5'UCC. or 5'CCG., depending on the location of the start codon. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Reagin: The antibody-like substances responsible for allergic phenomena; part of the gamma globulin fraction of serum. [NIH] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego function. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombinant Proteins: Proteins prepared by recombinant DNA technology. [NIH] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH]

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Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Repressor: Any of the specific allosteric protein molecules, products of regulator genes, which bind to the operator of operons and prevent RNA polymerase from proceeding into the operon to transcribe messenger RNA. [NIH] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH]

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Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk-Taking: Undertaking a task involving a challenge for achievement or a desirable goal in which there is a lack of certainty or a fear of failure. It may also include the exhibiting of certain behaviors whose outcomes may present a risk to the individual or to those associated with him or her. [NIH] Rod: A reception for vision, located in the retina. [NIH] Sagittal: The line of direction passing through the body from back to front, or any vertical plane parallel to the medial plane of the body and inclusive of that plane; often restricted to the medial plane, the plane of the sagittal suture. [NIH] Saline: A solution of salt and water. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salpingitis: 1. Inflammation of the uterine tube. 2. Inflammation of the auditory tube. [EU] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schwannoma: A tumor of the peripheral nervous system that begins in the nerve sheath (protective covering). It is almost always benign, but rare malignant schwannomas have been reported. [NIH] Sclera: The tough white outer coat of the eyeball, covering approximately the posterior five-

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sixths of its surface, and continuous anteriorly with the cornea and posteriorly with the external sheath of the optic nerve. [EU] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Sensitization: 1. Administration of antigen to induce a primary immune response; priming; immunization. 2. Exposure to allergen that results in the development of hypersensitivity. 3. The coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU] Septal: An abscess occurring at the root of the tooth on the proximal surface. [NIH] Septal Nuclei: Neural nuclei situated in the septal region. They have afferent and cholinergic efferent connections with a variety of forebrain and brainstem areas including the hippocampus, the lateral hypothalamus, the tegmentum, and the amygdala. Included are the dorsal, lateral, medial, and triangular septal nuclei, septofimbrial nucleus, nucleus of diagonal band, nucleus of anterior commissure, and the nucleus of stria terminalis. [NIH] Sequence Analysis: A multistage process that includes the determination of a sequence (protein, carbohydrate, etc.), its fragmentation and analysis, and the interpretation of the resulting sequence information. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Seroconversion: The change of a serologic test from negative to positive, indicating the development of antibodies in response to infection or immunization. [EU] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serologic Tests: Diagnostic procedures involving immunoglobulin reactions. [NIH] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Sexual Abstinence: Refraining from sexual intercourse. [NIH]

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Sexual Partners: Married or single individuals who share sexual relations. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal tap: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a lumbar puncture. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH] Spiral Ganglion: The sensory ganglion of the cochlear nerve. The cells of the spiral ganglion send fibers peripherally to the cochlear hair cells and centrally to the cochlear nuclei of the brain stem. [NIH]

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Spirochete: Lyme disease. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Status Epilepticus: Repeated and prolonged epileptic seizures without recovery of consciousness between attacks. [NIH] Sterile: Unable to produce children. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substrate: A substance upon which an enzyme acts. [EU] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Superinfection: A frequent complication of drug therapy for microbial infection. It may result from opportunistic colonization following immunosuppression by the primary pathogen and can be influenced by the time interval between infections, microbial

214 Syphilis

physiology, or host resistance. Experimental challenge and in vitro models are sometimes used in virulence and infectivity studies. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppurative: Consisting of, containing, associated with, or identified by the formation of pus. [NIH] Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH]

Survival Analysis: A class of statistical procedures for estimating the survival function (function of time, starting with a population 100% well at a given time and providing the percentage of the population still well at later times). The survival analysis is then used for making inferences about the effects of treatments, prognostic factors, exposures, and other covariates on the function. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]

Syphilis, Congenital: Syphilis acquired in utero and manifested by any of several characteristic tooth (Hutchinson's teeth) or bone malformations and by active mucocutaneous syphilis at birth or shortly thereafter. Ocular and neurologic changes may also occur. [NIH] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Tabes: A wasting condition, either of the whole body or of part of it. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Tenesmus: Straining, especially ineffectual and painful straining at stool or in urination. [EU] Testicular: Pertaining to a testis. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Thalamus: Paired bodies containing mostly gray substance and forming part of the lateral wall of the third ventricle of the brain. The thalamus represents the major portion of the diencephalon and is commonly divided into cellular aggregates known as nuclear groups.

Dictionary 215

[NIH]

Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thioredoxin: A hydrogen-carrying protein that participates in a variety of biochemical reactions including ribonucleotide reduction. Thioredoxin is oxidized from a dithiol to a disulfide during ribonucleotide reduction. The disulfide form is then reduced by NADPH in a reaction catalyzed by thioredoxin reductase. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombopenia: Reduction in the number of platelets in the blood. [NIH] Thromboses: The formation or presence of a blood clot within a blood vessel during life. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tonicity: The normal state of muscular tension. [NIH] Tonsil: A round-to-oval mass of lymphoid tissue embedded in the lateral wall of the pharynx situated on each side of the fauces, between the anterior and posterior pillars of the soft palate. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH]

216 Syphilis

Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Toxoplasmosis: The acquired form of infection by Toxoplasma gondii in animals and man. [NIH]

Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Transient Global Amnesia: Partial or total loss of memory. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Failure: A measure of the quality of health care by assessment of unsuccessful results of management and procedures used in combating disease, in individual cases or series. [NIH] Treponema: A genus of microorganisms of the order Spirochaetales, many of which are pathogenic and parasitic for man. [NIH] Treponema pallidum: The causative agent of venereal and non-venereal syphilis as well as yaws. [NIH] Treponemal Infections: Infections with bacteria of the genus Treponema. [NIH] Trichomonas: A genus of parasitic flagellate protozoans distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. [NIH] Trichomonas vaginalis: A species of trichomonas that produces a refractory vaginal discharge in females, as well as bladder and urethral infections in males. [NIH] Trypanosomiasis: Infection with protozoa of the genus Trypanosoma. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH]

Dictionary 217

Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urethritis: Inflammation of the urethra. [EU] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Uvea: The middle coat of the eyeball, consisting of the choroid in the back of the eye and the ciliary body and iris in the front of the eye. [NIH] Uveitis: An inflammation of part or all of the uvea, the middle (vascular) tunic of the eye, and commonly involving the other tunics (the sclera and cornea, and the retina). [EU] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vacuoles: Any spaces or cavities within a cell. They may function in digestion, storage, secretion, or excretion. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginal Discharge: A common gynecologic disorder characterized by an abnormal, nonbloody discharge from the genital tract. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vaginosis: A condition caused by the overgrowth of anaerobic bacteria (e. g., Gardnerella vaginalis), resulting in vaginal irritation and discharge. [NIH] Varicella: Chicken pox. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH]

218 Syphilis

Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Venous: Of or pertaining to the veins. [EU] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibular Nerve: The vestibular part of the 8th cranial nerve (vestibulocochlear nerve). The vestibular nerve fibers arise from neurons of Scarpa's ganglion and project peripherally to vestibular hair cells and centrally to the vestibular nuclei of the brain stem. These fibers mediate the sense of balance and head position. [NIH] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vibrio: A genus of Vibrionaceae, made up of short, slightly curved, motile, gram-negative rods. Various species produce cholera and other gastrointestinal disorders as well as abortion in sheep and cattle. [NIH] Vibrio cholerae: The etiologic agent of cholera. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Load: The quantity of measurable virus in the blood. Change in viral load, measured in plasma, is used as a surrogate marker in HIV disease progression. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virulent: A virus or bacteriophage capable only of lytic growth, as opposed to temperate phages establishing the lysogenic response. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and

Dictionary 219

kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Walkers: Walking aids generally having two handgrips and four legs. [NIH] War: Hostile conflict between organized groups of people. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Wound Infection: Invasion of the site of trauma by pathogenic microorganisms. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yaws: A systemic non-venereal infection of the tropics caused by Treponema pallidum subspecies pertenue. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zoster: A virus infection of the Gasserian ganglion and its nerve branches, characterized by discrete areas of vesiculation of the epithelium of the forehead, the nose, the eyelids, and the cornea together with subepithelial infiltration. [NIH] Zygote: The fertilized ovum. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

221

INDEX A Abdomen, 167, 173, 182, 189, 195, 213, 215 Abscess, 22, 167, 188, 211 Acetone, 110, 167, 194 Acetylcholine, 167, 175 Acoustic, 3, 167, 218 Acquired Immunodeficiency Syndrome, 50, 151, 167 Acyclovir, 122, 167 Adjustment, 27, 167 Adsorption, 98, 167 Adsorptive, 167 Adverse Effect, 167, 212 Affinity, 13, 29, 167, 171, 200 Affinity Chromatography, 13, 167 Agar, 168 Agarose, 22, 168 Agglutinins, 164, 168 Aggressiveness, 24, 168 Algorithms, 168, 172 Alienation, 141, 168 Alkaloid, 168, 176 Allergen, 168, 211 Alternative medicine, 128, 168 Alum, 41, 168, 176 Aluminum, 168 Amino Acid Sequence, 98, 101, 106, 168, 169, 187 Amino Acids, 168, 176, 184, 187, 201, 203, 205, 207, 210, 216, 217 Ammonia, 168, 217 Amphetamines, 168, 176 Amplification, 37, 84, 168 Amygdala, 169, 195, 211 Anaerobic, 111, 169, 217 Anal, 10, 148, 169, 184, 186 Analog, 167, 169 Analytes, 146, 169 Anaphylatoxins, 169, 177 Anatomical, 169, 192 Anemia, 169, 197 Animal model, 20, 169 Annealing, 169, 204 Antibacterial, 38, 169, 212 Antibiotic, 13, 20, 25, 106, 115, 148, 149, 153, 169, 171, 174, 184, 202, 212, 214 Antibodies, Anticardiolipin, 169, 170 Antibodies, Antiphospholipid, 169, 170

Antibody, 4, 20, 24, 32, 43, 96, 97, 101, 102, 103, 105, 107, 108, 109, 110, 112, 119, 129, 164, 167, 169, 170, 173, 177, 184, 189, 190, 191, 192, 199, 208, 211, 212 Anticoagulant, 129, 170, 206, 219 Antidepressant, 170, 173 Antigen-Antibody Complex, 96, 170, 177 Antigen-presenting cell, 170, 180 Anti-inflammatory, 170, 171, 188, 192, 205 Anti-Inflammatory Agents, 170, 171 Antimetabolite, 167, 170 Antimicrobial, 47, 170, 182 Antiphospholipid Syndrome, 46, 129, 169, 170 Antiseptic, 167, 170 Antiserum, 18, 170 Antiviral, 167, 170, 193 Anus, 149, 169, 170, 173, 193 Aperture, 170, 207 Apolipoproteins, 170, 195 Applicability, 16, 170 Aqueous, 109, 170, 172, 179, 183, 195 Arachidonic Acid, 170, 206 Arterial, 170, 171, 175, 191, 206 Arteries, 171, 173, 179, 196, 198, 199 Arteriolar, 25, 171 Arterioles, 171, 173 Artifacts, 27, 171 Aseptic, 171, 201, 213 Aspirin, 130, 171 Assay, 21, 32, 33, 34, 48, 76, 77, 97, 101, 103, 105, 107, 112, 123, 171, 191, 208 Astringents, 171, 198 Astrocytes, 171, 188, 200 Asymptomatic, 39, 56, 60, 106, 171, 188 Atrial, 171, 219 Atrial Fibrillation, 171, 219 Attenuated, 171, 181 Auditory, 3, 171, 176, 210 Autacoids, 171, 192 Autonomic, 167, 171, 179, 203 Autonomic Nervous System, 171, 179, 203 Azithromycin, 36, 73, 75, 77, 91, 128, 171 B Bacterial Infections, 13, 111, 172 Bactericidal, 172, 184 Bacteriophage, 172, 216, 218 Bacterium, 8, 13, 21, 172

222 Syphilis

Basal Ganglia, 172, 186, 195 Base, 30, 43, 172, 174, 180, 187, 194, 214 Basement Membrane, 172, 185 Benign, 165, 172, 186, 189, 200, 210, 219 Bilateral, 3, 39, 40, 172 Binding Sites, 30, 172 Biochemical, 22, 28, 29, 170, 172, 195, 211, 215 Biochemical reactions, 172, 215 Biological response modifier, 172, 193 Biological Transport, 172, 181 Biopsy, 59, 164, 172 Biotechnology, 31, 35, 112, 118, 128, 139, 172 Biotype, 13, 105, 172 Bladder, 172, 206, 216, 217 Blastocyst, 172, 178, 183 Blennorrhoea, 173, 188 Blood pressure, 173, 199 Blood transfusion, 6, 173 Blood vessel, 99, 173, 174, 183, 189, 196, 203, 213, 215, 217 Blot, 54, 105, 173, 192 Blotting, Western, 173, 192 Body Fluids, 97, 173 Bone Cements, 173, 205 Bone Marrow, 173, 191, 196 Bone scan, 173, 210 Bowel, 169, 173, 181 Bowel Movement, 173, 181 Branch, 48, 151, 159, 173, 196, 201, 202, 207, 212, 215 Buccal, 173, 196 Buffaloes, 29, 173 Bupropion, 10, 173 C Calcium, 173, 177, 202, 207 Canonical, 98, 174 Carbohydrate, 174, 188, 205, 211 Carbon Dioxide, 174, 186, 191, 209 Carcinogenic, 174, 193, 201 Cardiovascular, 165, 174, 179, 211 Cardiovascular System, 174, 179 Carotene, 174, 209 Carrier Proteins, 174, 208 Case report, 3, 37, 50, 56, 64, 67, 115, 174, 176 Case series, 174, 176 Catecholamine, 174, 182, 203 Causal, 29, 174, 184, 193 Cefmetazole, 33, 174 Ceftriaxone, 25, 36, 75, 127, 174

Cell, 8, 13, 14, 21, 25, 27, 34, 55, 101, 110, 169, 170, 171, 172, 174, 175, 177, 179, 180, 182, 183, 185, 186, 187, 188, 189, 191, 193, 194, 195, 197, 199, 204, 205, 206, 208, 209, 211, 215, 216, 217, 219 Cell Division, 172, 174, 197, 204, 206, 211 Cell membrane, 27, 172, 174, 194, 204 Cell Movement, 21, 174 Central Nervous System, 167, 168, 171, 174, 176, 179, 180, 186, 198, 199, 203, 211 Centrifugation, 108, 175 Cerebral, 25, 71, 172, 175, 189, 197 Cerebrospinal, 118, 175, 196, 212 Cerebrospinal fluid, 118, 175, 196, 212 Cerebrum, 175 Chancre, 12, 149, 175 Check-up, 151, 175 Chemotactic Factors, 175, 177 Chemotaxis, 21, 175 Chlamydia, 6, 7, 9, 10, 11, 12, 15, 16, 17, 29, 46, 51, 90, 116, 146, 148, 175 Cholera, 28, 175, 218 Cholesterol, 109, 175, 195, 196 Cholesterol Esters, 175, 195 Choline, 109, 175 Choriocarcinoma, 175, 187, 198 Chromosomal, 168, 175 Chromosome, 175, 195, 211 Chronic, 7, 8, 12, 13, 20, 21, 80, 105, 106, 175, 181, 192, 213, 214 Chylomicrons, 175, 195 CIS, 33, 175, 209 Clear cell carcinoma, 176, 180 Clinical Medicine, 54, 73, 176, 205 Clinical study, 118, 119, 176 Clinical trial, 5, 10, 12, 91, 92, 139, 176, 182, 207, 208 Cloning, 30, 172, 176, 193 Coagulation, 170, 173, 176, 215, 219 Coca, 176 Cocaine, 6, 31, 121, 176, 179 Cochlear, 176, 212, 215, 218 Cochlear Diseases, 176, 215 Cochlear Nerve, 176, 212, 218 Cochlear Nucleus, 176, 218 Codon, 176, 187, 208 Cofactor, 21, 177, 200, 206, 215 Cohort Studies, 12, 177, 184 Collagen, 172, 177, 178, 189 Colloidal, 112, 177, 211 Communicable disease, 38, 177 Communicable Disease Control, 38, 177

Index 223

Complement, 13, 169, 177, 187, 211 Complementary and alternative medicine, 83, 88, 177 Complementary medicine, 72, 83, 85, 177 Computational Biology, 139, 178 Computed tomography, 58, 178, 210 Computerized axial tomography, 178, 210 Computerized tomography, 178 Conception, 27, 104, 175, 178, 179, 185, 187, 198, 205, 213 Concomitant, 24, 178 Condoms, 121, 148, 149, 150, 151, 165, 178 Cones, 178, 209 Confounding, 23, 178 Congenita, 118, 178 Congestion, 178, 184 Connective Tissue, 170, 173, 177, 178, 185, 186, 196, 210, 214 Connective Tissue Diseases, 170, 178 Consciousness, 178, 180, 181, 213 Consultation, 123, 141, 178 Consumption, 178, 180, 209 Contact Tracing, 19, 178 Contamination, 99, 178 Contraception, 27, 179 Contraceptive, 9, 104, 132, 179 Contraindications, ii, 179 Cornea, 57, 179, 194, 211, 217, 219 Corneum, 179, 184 Coronary, 179, 198, 199 Coronary Thrombosis, 179, 198, 199 Corpus, 179, 203 Cortex, 176, 179, 190 Cortical, 25, 44, 179, 211 Cortisone, 179, 205 Cost-benefit, 47, 179 Crack Cocaine, 6, 121, 141, 179 Cranial, 176, 179, 193, 203, 218 Craniocerebral Trauma, 179, 215 Crossing-over, 179, 208 Cryptosporidiosis, 171, 179 Curative, 179, 210, 215 Cutaneous, 8, 44, 47, 76, 123, 179, 188, 194, 195, 196 Cyclic, 69, 179, 203, 206 Cytoplasm, 174, 179, 183, 210 D Data Collection, 179, 186 Databases, Bibliographic, 139, 180 Deamination, 180, 217 Degenerative, 180, 188, 190 Dehydration, 175, 180

Delivery of Health Care, 180, 187, 189 Delusions, 180, 207 Dementia, 4, 25, 45, 62, 63, 148, 167, 180, 200 Denaturation, 180, 204 Dendrites, 180, 200 Dendritic, 8, 37, 180 Dendritic cell, 8, 37, 180 Density, 175, 180, 195 Dermal, 8, 180 Dermatitis, 15, 180 DES, 115, 169, 180 Developing Countries, 5, 180 Dextroamphetamine, 180, 198 Diabetes Mellitus, 180, 190, 203 Diagnostic Errors, 105, 181 Diagnostic procedure, 95, 128, 181, 211 Diarrhea, 27, 179, 181 Diffusion, 15, 17, 172, 181, 189, 193 Digestion, 173, 181, 196, 213, 217 Digestive system, 92, 181 Dilution, 110, 181 Direct, iii, 6, 14, 49, 99, 131, 176, 181, 182, 204, 208 Discrimination, 120, 181 Disease Progression, 181, 218 Disease Transmission, 18, 181 Disease Transmission, Horizontal, 181 Disease Transmission, Vertical, 181 Disinfectant, 181, 185 Dissociation, 167, 181 Distal, 104, 181, 207 Dizziness, 120, 181 Domesticated, 181, 189 Dopamine, 173, 176, 180, 182 Double-blinded, 10, 182 Douching, 9, 182 Doxycycline, 91, 132, 182 Drug Interactions, 133, 182 Drug Resistance, 16, 182 Drug Tolerance, 182 Dura mater, 182, 198, 201 Dysentery, 15, 182 E Ectopic, 7, 9, 182 Ectopic Pregnancy, 9, 182 Effector, 8, 167, 177, 182, 203 Effector cell, 8, 182 Efficacy, 10, 19, 25, 33, 47, 91, 174, 182 Elective, 20, 182 Electrons, 172, 182, 194, 208 Emaciation, 167, 183

224 Syphilis

Emboli, 183, 219 Embolism, 183, 207, 219 Embolization, 183, 219 Embryo, 172, 183, 205, 213 Embryo Transfer, 183, 205 Emulsion, 183, 186 Encephalitis, 59, 183 Encephalitis, Viral, 183 Encephalopathy, 4, 25, 183 Endemic, 80, 106, 116, 175, 183, 197 Endocarditis, 183, 188 Endotoxins, 177, 183 Environmental Health, 138, 140, 183 Enzymatic, 173, 174, 177, 184, 185, 204, 209 Enzyme-Linked Immunosorbent Assay, 20, 32, 42, 49, 184 Epidemic, 5, 6, 27, 39, 61, 78, 113, 114, 126, 141, 184 Epidemiologic Studies, 184, 187 Epidemiological, 11, 19, 41, 52, 105, 184 Epidermal, 184, 219 Epidermis, 8, 179, 184, 190, 207 Epithalamus, 184, 195 Epithelial, 13, 60, 172, 184, 190 Epithelium, 172, 175, 184, 194, 202, 219 Erectile, 184, 203 Erythema, 20, 184 Erythrocytes, 169, 173, 184, 208, 211 Erythromycin, 171, 184 Esophagus, 181, 184, 203, 213 Ethanol, 109, 184 Ethnic Groups, 12, 185 Exhaustion, 185, 197 Exogenous, 167, 185 Extracellular, 13, 171, 178, 185, 200 Extracellular Matrix, 13, 178, 185 Extracellular Space, 185 Extraction, 14, 185 F Facial, 61, 185, 202 False Positive Reactions, 98, 185 Family Planning, 9, 27, 139, 185 Fat, 170, 173, 174, 183, 185, 194, 195, 214 Fatigue, 162, 185, 190 Fatty acids, 185, 188, 206 Fertilization in Vitro, 185, 205 Fetus, 150, 185, 205, 213, 217 Fibrin, 102, 103, 185, 203, 215 Fibrinogen, 102, 185, 215 Fibrinolytic, 102, 185 Fibronectin, 30, 103, 185 Fibrosis, 185, 210

Filtration, 32, 112, 185 Fixation, 119, 185, 211 Flagellin, 97, 186 Flagellum, 22, 27, 97, 186, 216 Fluorescence, 102, 103, 110, 186 Focus Groups, 16, 186 Fold, 150, 186 Fovea, 186 Fungi, 186, 198, 219 G Gallbladder, 181, 186 Ganglia, 167, 186, 200, 203 Ganglion, 186, 212, 218, 219 Gas, 168, 174, 181, 186, 191, 200, 213 Gastrointestinal, 179, 184, 186, 197, 211, 218 Gastrointestinal tract, 184, 186, 211 Gene, 12, 14, 21, 22, 23, 26, 30, 33, 37, 63, 98, 100, 101, 118, 172, 186, 187, 193, 201, 211 Gene Expression, 21, 187 Genetic Code, 187, 200 Genetic Counseling, 14, 187 Genetic Engineering, 172, 176, 187 Genetic testing, 14, 187, 204 Genetics, 14, 17, 187 Genital, 8, 30, 90, 105, 116, 127, 148, 162, 176, 187, 217 Genitourinary, 7, 46, 152, 187, 217 Genomics, 30, 187 Genotype, 172, 187, 203 Geographic Locations, 15, 187 Germanium, 122, 187 Gestation, 187, 203, 213 Gestational, 57, 187, 198 Gestational trophoblastic disease, 57, 187, 198 Gestational trophoblastic neoplasia, 187, 198 Gestational trophoblastic tumor, 187, 198 Giant Cells, 187, 210 Gland, 175, 179, 188, 196, 202, 206, 211, 213 Gliosis, 25, 188 Glucocorticoid, 188, 205 Glucose, 21, 180, 188, 190 Glycerol, 188, 204 Glycerophospholipids, 188, 204 Glycogen, 175, 188 Glycoprotein, 39, 185, 187, 188, 215 Gonorrhoea, 30, 39, 47, 51, 69, 71, 75, 76, 116, 188

Index 225

Governing Board, 188, 205 Government Agencies, 140, 188, 205 Graft, 188, 190 Grafting, 37, 188, 192 Gram-negative, 106, 174, 175, 188, 205, 218 Gram-Negative Bacteria, 106, 188, 205 Gram-positive, 174, 188, 213 Granuloma, 63, 80, 189 Granuloma Annulare, 63, 80, 189 Gravidity, 189, 202 Groin, 149, 162, 189 Growth, 26, 101, 110, 169, 170, 180, 189, 190, 193, 197, 200, 201, 204, 218 Guinea Pigs, 34, 189 Gyrus Cinguli, 189, 195 H Haematoma, 189 Haemodialysis, 64, 189 Haemorrhage, 56, 189 Half-Life, 174, 189 Haptens, 167, 189, 208 Health Care Costs, 7, 189 Health Expenditures, 189 Health Policy, 38, 189 Health Promotion, 16, 114, 140, 150, 189 Health Services, 76, 149, 180, 189 Heart failure, 148, 190 Hemoglobin, 169, 184, 190, 195 Hemorrhage, 179, 190, 208, 213 Hepatitis, 4, 10, 15, 31, 36, 49, 50, 52, 55, 66, 84, 99, 102, 112, 116, 190, 198 Hepatocytes, 190 Heredity, 186, 187, 190 Herpes, 46, 59, 62, 66, 74, 90, 105, 116, 148, 167, 190 Herpes Simplex Encephalitis, 62, 190 Herpes Zoster, 190 Heterogeneity, 23, 26, 27, 167, 190 Hippocampus, 190, 195, 211 Homologous, 179, 190, 199, 211 Hormone, 179, 180, 190, 197, 202 Horny layer, 184, 190 Horseradish Peroxidase, 184, 190 Host, 13, 21, 22, 30, 98, 103, 109, 172, 190, 191, 214, 217, 218 Human papillomavirus, 23, 190 Hydrogen, 172, 174, 180, 190, 198, 203, 215 Hydrolysis, 191, 205, 207 Hydrophilic, 18, 191 Hydrophobic, 17, 107, 188, 191, 195 Hygienic, 182, 191 Hypercapnia, 25, 191

Hypersensitivity, 168, 191, 211 Hypodermic, 99, 191 Hypomania, 41, 191 Hypothalamus, 171, 191, 195, 211 I Id, 45, 81, 85, 152, 153, 158, 160, 191 Idiopathic, 191, 210 Immune adjuvant, 168, 191 Immune Complex Diseases, 170, 191 Immune function, 80, 191 Immune response, 7, 8, 12, 22, 55, 97, 168, 170, 179, 189, 191, 192, 211, 217, 218 Immune Sera, 191 Immune system, 16, 111, 170, 182, 191, 192, 196, 217, 219 Immunity, 17, 22, 26, 32, 67, 110, 167, 191, 192, 216 Immunization, 13, 23, 26, 191, 211 Immunoassay, 32, 33, 42, 47, 56, 103, 169, 184, 191 Immunoblotting, 35, 77, 192 Immunocompromised, 120, 192 Immunodeficiency syndrome, 113, 114, 122, 123, 141, 148, 192 Immunofluorescence, 34, 76, 102, 164, 192 Immunogenic, 23, 192, 208 Immunoglobulin, 32, 96, 169, 192, 199, 211 Immunologic, 175, 191, 192 Immunology, 8, 21, 29, 45, 76, 77, 96, 167, 190, 192 Impairment, 14, 25, 192, 198, 207 Implantation, 178, 192 In situ, 129, 192 In vitro, 8, 15, 25, 98, 101, 103, 106, 108, 109, 183, 192, 204, 211, 214, 215 In vivo, 8, 192 Incubation, 149, 192 Indicative, 115, 192, 202, 217 Indomethacin, 80, 192 Infancy, 192, 210 Infarction, 192 Infertility, 7, 193 Infiltration, 193, 219 Informed Consent, 74, 193 Ingestion, 193, 204 Inhalation, 193, 204 Initiation, 8, 193 Inner ear, 174, 176, 193 Insertional, 22, 193 Insight, 14, 24, 28, 193 Interferon, 37, 193 Interferon-alpha, 193

226 Syphilis

Intermittent, 3, 103, 193 Interpersonal Relations, 29, 193 Interstitial, 119, 185, 193 Intervention Studies, 12, 193 Intestines, 175, 182, 186, 193 Intracellular, 192, 193, 197, 206 Intracellular Membranes, 193, 197 Intracranial Hypertension, 193, 215 Intramuscular, 4, 128, 193 Intramuscular injection, 4, 193 Intravenous, 50, 193 Intrinsic, 20, 167, 172, 194 Invasive, 191, 194, 197 Involuntary, 194, 199, 209 Ions, 172, 181, 191, 194, 205, 207 Iris, 179, 194, 207, 217 Irritants, 182, 194 Isotonic, 106, 194 J Joint, 148, 163, 194, 214 K Kb, 138, 194 Keratitis, 119, 194 Ketone Bodies, 167, 194 Kinetics, 23, 194 L Labile, 177, 194 Large Intestine, 181, 193, 194, 208 Latency, 103, 194 Latent, 149, 151, 194 Least-Squares Analysis, 194, 209 Lectin, 195, 197 Leishmaniasis, 195, 203 Lens, 178, 195 Leptospirosis, 15, 39, 98, 195 Lesion, 3, 7, 105, 148, 163, 188, 189, 195, 196, 217 Leucine, 33, 195 Leukocytes, 173, 175, 192, 193, 195 Leukoplakia, 70, 195 Library Services, 158, 195 Ligament, 195, 206 Likelihood Functions, 195, 209 Limbic, 62, 169, 189, 195 Limbic System, 62, 169, 189, 195 Linear Models, 195, 209 Linkages, 7, 190, 195 Lipid, 8, 106, 170, 175, 188, 195 Lipopolysaccharide, 188, 195 Lipoprotein, 9, 20, 21, 188, 195, 196 Liver, 170, 181, 183, 186, 188, 190, 195, 196, 205, 210, 217

Liver scan, 196, 210 Localization, 33, 196 Localized, 102, 167, 186, 189, 192, 196, 204, 217 Locomotion, 186, 196, 204 Logistic Models, 196, 209 Low-density lipoprotein, 195, 196 Lumbar, 24, 164, 196, 212 Lumbar puncture, 24, 164, 196, 212 Lupus, 58, 86, 129, 169, 170, 196, 214 Lymph, 59, 162, 196, 210 Lymph node, 162, 196, 210 Lymphatic, 192, 196, 213, 215 Lymphatic system, 196, 213, 215 Lymphocyte, 167, 170, 196 Lymphocyte Count, 167, 196 Lymphoid, 169, 196, 215 Lymphoma, 42, 196 Lysine, 98, 196 Lytic, 196, 211, 218 M Magnetic Resonance Imaging, 62, 197, 210 Malaria, 6, 80, 84, 197 Malaria, Falciparum, 197 Malaria, Vivax, 197 Malignancy, 185, 197, 202 Malignant, 58, 167, 175, 197, 200, 210 Mania, 191, 197 Manic, 197, 207 Manic-depressive psychosis, 197, 207 Marital Status, 27, 197 Medial, 176, 189, 197, 210, 211 Medical Records, 197, 210 Medical Staff, 182, 197 MEDLINE, 139, 197 Meiosis, 197, 199 Membrane Proteins, 21, 32, 103, 106, 197 Memory, 8, 60, 180, 197, 216 Meninges, 174, 175, 179, 182, 198 Meningitis, 148, 188, 198 Mental Disorders, 93, 198, 207 Mental Health, iv, 5, 93, 138, 142, 198, 207 Mercury, 80, 84, 198 Methamphetamine, 17, 198 MI, 38, 166, 198 Mice Minute Virus, 198, 202 Microbiology, 20, 29, 37, 42, 48, 49, 50, 63, 69, 71, 77, 80, 84, 85, 101, 106, 118, 198 Microorganism, 98, 177, 198, 202, 219 Microscopy, 21, 102, 103, 105, 172, 190, 198 Migrans, 20, 198 Migration, 8, 198, 200

Index 227

Mobility, 16, 198 Mode of Transmission, 148, 198 Modeling, 15, 17, 54, 198 Molar pregnancy, 187, 198 Molecular, 13, 21, 22, 33, 59, 60, 101, 111, 139, 143, 169, 172, 178, 185, 186, 198 Molecule, 20, 167, 170, 172, 177, 181, 182, 191, 193, 195, 198, 208, 217 Monitor, 6, 141, 199, 200 Monoclonal, 105, 112, 192, 199 Monoclonal antibodies, 105, 192, 199 Mononuclear, 189, 199 Morphology, 105, 199 Motility, 21, 27, 105, 110, 192, 199, 211 Mucocutaneous, 60, 195, 199, 214 Mucosa, 196, 199 Mucus, 173, 182, 199 Multivalent, 26, 199 Mutagenesis, 21, 23, 199 Mutagens, 199 Myocardial infarction, 179, 198, 199, 219 Myocardium, 198, 199 Myoclonus, 44, 199 N NCI, 1, 92, 137, 176, 199 Necrosis, 192, 198, 199, 210 Need, 3, 19, 28, 105, 113, 119, 121, 129, 140, 148, 149, 154, 188, 199 Needle Sharing, 149, 200 Neonatal, 188, 200 Neoplasm, 200, 210 Neoplastic, 196, 200 Nephropathy, 59, 200 Nerve, 101, 176, 180, 186, 200, 201, 202, 209, 210, 211, 213, 218, 219 Nervous System, 40, 97, 165, 171, 174, 200, 203, 214 Networks, 17, 18, 27, 28, 29, 30, 31, 61, 200 Neuroglia, 188, 200 Neurologic, 200, 214 Neurons, 176, 180, 186, 200, 218 Nickel, 111, 200 Nitrogen, 168, 186, 200 Nuclear, 172, 183, 186, 195, 199, 200, 214 Nuclei, 169, 176, 182, 184, 187, 197, 200, 211, 212, 218 Nucleic acid, 100, 187, 199, 200 Nucleus, 171, 176, 179, 197, 199, 200, 206, 211, 213 O Observational study, 10, 200 Ocular, 37, 64, 66, 80, 201, 214

Odds Ratio, 201, 209 Oncogenic, 23, 201 Oophoritis, 188, 201 Open Reading Frames, 29, 201 Operon, 21, 201, 209 Ophthalmology, 37, 38, 40, 64, 66, 186, 201 Opportunistic Infections, 5, 167, 201 Opsin, 201, 209 Organ Culture, 9, 201, 215 Organelles, 175, 179, 201 Orthostatic, 72, 201 Ossification, 201, 210 Otolaryngologist, 120, 201 Otolaryngology, 3, 38, 64, 72, 76, 120, 123, 201 Otology, 40, 58, 120, 201 Outpatient, 56, 201 P Pachymeningitis, 198, 201 Palate, 201, 215 Palliative, 202, 215 Palsy, 62, 202 Pancreas, 181, 202 Papillomavirus, 202 Papule, 163, 175, 202 Parasitic, 179, 182, 202, 216 Parathyroid, 202, 210 Parathyroid Glands, 202, 210 Parity, 27, 202 Parotid, 202, 210 Particle, 23, 32, 42, 49, 202, 216 Parvovirus, 74, 198, 202 Patch, 195, 202 Pathogen, 23, 98, 192, 202, 213 Pathogenesis, 7, 13, 14, 15, 17, 21, 22, 25, 202 Pathologic, 172, 179, 191, 202 Pathophysiology, 25, 120, 202 Patient Education, 148, 156, 158, 166, 202 Pelvic, 7, 9, 116, 148, 202, 206 Pelvic inflammatory disease, 7, 9, 148, 202 Penicillin, 4, 36, 47, 50, 66, 80, 84, 91, 105, 119, 120, 128, 148, 202 Penis, 149, 165, 178, 203 Pentamidine, 122, 203 Peptide, 20, 23, 203, 205, 206, 207 Perfusion, 71, 203 Pericardium, 203, 214 Perinatal, 54, 203 Periodontal disease, 15, 21, 203 Peripheral Nervous System, 202, 203, 210 Peritonitis, 188, 203

228 Syphilis

Petechiae, 189, 203 PH, 55, 71, 141, 203 Phallic, 186, 203 Pharmacologic, 171, 189, 203, 216 Pharmacotherapy, 10, 203 Pharynx, 203, 215 Phenotype, 24, 203 Phosphodiesterase, 33, 203 Phospholipids, 129, 169, 170, 185, 195, 204 Physical Examination, 175, 204 Physiologic, 189, 194, 199, 204, 206, 208 Physiology, 15, 25, 204, 214 Pigment, 60, 204 Pilot study, 36, 204 Pinta, 104, 106, 116, 204 Plague, 74, 204 Plants, 168, 174, 175, 176, 188, 195, 199, 204, 216 Plasma cells, 169, 204 Poisoning, 80, 198, 204 Policy Making, 188, 204 Polymerase, 33, 37, 45, 63, 100, 101, 204, 209 Polymerase Chain Reaction, 45, 204 Polymorphic, 12, 23, 26, 204 Polymorphism, 18, 205 Polypeptide, 21, 98, 109, 168, 177, 185, 205, 206, 219 Polysaccharide, 168, 170, 205 Population Growth, 27, 205 Porins, 13, 205 Porosity, 103, 205 Posterior, 66, 169, 184, 194, 202, 205, 210, 215 Practice Guidelines, 142, 152, 205 Precursor, 17, 102, 170, 175, 182, 184, 205, 207 Prednisolone, 205 Prednisone, 120, 205 Pregnancy Outcome, 7, 10, 37, 47, 205 Prenatal, 44, 45, 52, 71, 149, 183, 205 Prenatal Care, 149, 205 Prevalence, 4, 6, 12, 16, 17, 19, 27, 30, 31, 44, 52, 53, 55, 59, 66, 72, 84, 115, 201, 205 Prognostic factor, 205, 214 Progression, 169, 205 Progressive, 3, 62, 180, 182, 189, 199, 205 Prophase, 199, 206 Prophylaxis, 59, 106, 111, 206, 217, 219 Proportional, 184, 206 Prospective study, 29, 206 Prostaglandin, 80, 206

Prostaglandins A, 192, 206 Prostate, 23, 206 Protein C, 28, 119, 168, 170, 172, 176, 195, 206, 217 Protein Conformation, 168, 206 Protein S, 98, 118, 172, 184, 187, 206, 210, 214 Proteolytic, 177, 185, 207 Prothrombin, 207, 215 Protocol, 115, 207 Protozoa, 182, 195, 198, 207, 216 Proximal, 104, 181, 207, 211 Psychiatric, 4, 16, 198, 207 Psychiatry, 10, 11, 17, 24, 41, 45, 185, 207 Psychopathology, 10, 207 Psychosis, 62, 148, 187, 207 Public Policy, 139, 207 Publishing, 32, 141, 207 Pulmonary, 67, 173, 178, 207, 214, 218, 219 Pulmonary Embolism, 207, 219 Pulse, 199, 207 Pupil, 39, 67, 179, 207 Purpura, 189, 207 Purulent, 188, 208, 217 R Race, 115, 198, 208 Radiation, 179, 186, 208, 210, 219 Radioactive, 173, 189, 191, 192, 196, 199, 200, 201, 208, 210 Radioimmunoassay, 107, 108, 208 Radiologist, 185, 208 Randomized, 10, 11, 36, 54, 182, 208 Reactivation, 25, 208 Reading Frames, 30, 208 Reagent, 107, 108, 109, 208 Reagin, 4, 32, 34, 42, 64, 65, 84, 97, 109, 164, 208 Reality Testing, 207, 208 Receptor, 21, 170, 182, 208, 211 Recombinant, 13, 26, 33, 35, 42, 47, 49, 71, 77, 101, 208, 217 Recombinant Proteins, 26, 208 Recombination, 13, 208 Rectum, 170, 173, 181, 186, 194, 206, 208 Red blood cells, 108, 184, 208 Reductase, 208, 215 Refer, 1, 173, 177, 181, 186, 190, 196, 205, 207, 208, 218 Reflex, 44, 209 Refraction, 209, 212 Refractory, 209, 216 Regimen, 66, 149, 182, 203, 209

Index 229

Regression Analysis, 9, 30, 209 Relative risk, 23, 30, 209 Repressor, 201, 209 Reproduction Techniques, 205, 209 Respiration, 174, 199, 209 Restoration, 208, 209 Retina, 178, 195, 200, 209, 210, 217 Retinal, 60, 209 Retinol, 209 Retrospective, 4, 210 Retrospective study, 4, 210 Ribosome, 210, 216 Rickets, 41, 210 Risk factor, 6, 12, 23, 36, 43, 59, 68, 70, 184, 196, 206, 209, 210 Risk-Taking, 29, 210 Rod, 172, 210 S Sagittal, 25, 210 Saline, 109, 110, 210 Salivary, 181, 210 Salivary glands, 181, 210 Salpingitis, 188, 210 Saphenous, 37, 210 Saphenous Vein, 37, 210 Sarcoidosis, 40, 210 Sarcoma, 5, 10, 123, 210 Scans, 25, 210 Schwannoma, 3, 210 Sclera, 210, 217 Secretion, 175, 199, 211, 217 Segregation, 208, 211 Seizures, 211, 213 Semen, 206, 211 Semisynthetic, 174, 211 Sensitization, 107, 211 Septal, 195, 211 Septal Nuclei, 195, 211 Sequence Analysis, 26, 211 Sequencing, 15, 204, 211 Seroconversion, 16, 30, 70, 211 Serologic, 6, 16, 23, 34, 35, 49, 76, 77, 96, 98, 109, 110, 119, 191, 211 Serologic Tests, 109, 119, 211 Serology, 66, 115, 116, 117, 164, 211 Serotonin, 203, 211 Serum Albumin, 208, 211 Sexual Abstinence, 148, 149, 151, 211 Sexual Partners, 6, 12, 17, 23, 121, 122, 212 Shock, 199, 212, 216 Side effect, 104, 122, 131, 149, 167, 174, 212, 215

Signs and Symptoms, 115, 151, 212 Skeleton, 194, 206, 212 Skull, 179, 212, 214 Socioeconomic Factors, 31, 212 Solvent, 167, 185, 188, 212 Somatic, 195, 197, 203, 212 Spatial disorientation, 181, 212 Specialist, 150, 154, 212 Specificity, 67, 96, 97, 104, 107, 108, 109, 167, 212 Spectrum, 15, 174, 212 Spinal cord, 148, 171, 175, 182, 186, 198, 200, 201, 203, 209, 212 Spinal tap, 196, 212 Spinous, 184, 212 Spiral Ganglion, 176, 212, 218 Spirochete, 8, 13, 15, 20, 21, 22, 23, 26, 32, 33, 90, 97, 101, 213, 214 Spleen, 80, 196, 210, 213 Spontaneous Abortion, 205, 213 Staging, 210, 213 Status Epilepticus, 44, 56, 64, 213 Sterile, 99, 171, 202, 213 Sterility, 193, 213 Stillbirth, 149, 205, 213 Stimulant, 180, 198, 213 Stimulus, 182, 194, 209, 213 Stomach, 181, 184, 186, 190, 193, 203, 213 Strand, 204, 213 Streptococcus, 7, 213 Stress, 27, 171, 174, 213 Stroke, 93, 138, 146, 213 Subacute, 192, 213 Subclinical, 123, 192, 211, 213 Subspecies, 106, 212, 213, 219 Substrate, 101, 102, 184, 213 Suction, 185, 213 Superinfection, 80, 213 Suppression, 16, 115, 214 Suppurative, 188, 214 Surfactant, 107, 214 Survival Analysis, 83, 214 Sympathomimetic, 180, 182, 198, 214 Symphysis, 206, 214 Symptomatic, 106, 165, 214 Synergistic, 22, 214 Systemic, 58, 86, 97, 132, 165, 169, 170, 173, 191, 192, 193, 205, 210, 214, 216, 219 Systemic disease, 97, 214 Systemic lupus erythematosus, 58, 169, 170, 191, 214

230 Syphilis

T Tabes, 146, 214 Temporal, 120, 169, 190, 214 Tenesmus, 182, 214 Testicular, 105, 214 Testis, 175, 214 Tetracycline, 182, 214 Thalamus, 184, 195, 214 Therapeutics, 22, 98, 133, 215 Thermal, 181, 204, 215 Thigh, 189, 215 Thioredoxin, 33, 215 Thorax, 167, 196, 215 Thrombin, 102, 185, 206, 207, 215 Thrombomodulin, 206, 215 Thrombopenia, 170, 215 Thromboses, 170, 215 Thrombosis, 46, 206, 213, 215 Thymus, 191, 196, 215 Tinnitus, 3, 120, 215, 218 Tissue Culture, 101, 109, 110, 215 Tomography, 22, 215 Tonic, 40, 215 Tonicity, 194, 215 Tonsil, 40, 215 Topical, 132, 171, 184, 215 Toxic, iv, 191, 203, 215, 216 Toxicity, 182, 198, 216 Toxicology, 10, 140, 216 Toxins, 170, 183, 192, 199, 216 Toxoplasmosis, 74, 171, 216 Trace element, 200, 216 Transduction, 21, 216 Transfection, 172, 216 Transfer Factor, 191, 216 Transfusion, 36, 66, 216 Transient Global Amnesia, 62, 216 Translation, 98, 116, 184, 208, 216 Transplantation, 183, 191, 216 Trauma, 199, 216, 219 Treatment Failure, 141, 216 Treponemal Infections, 103, 106, 216 Trichomonas, 9, 11, 30, 104, 216 Trichomonas vaginalis, 104, 216 Trypanosomiasis, 203, 216 Tuberculosis, 111, 115, 178, 196, 216 U Ulcer, 65, 105, 165, 217 Ulceration, 56, 67, 217 Unconscious, 191, 217 Urea, 18, 217 Urethra, 203, 206, 217

Urethritis, 46, 86, 116, 148, 188, 217 Urinary, 174, 187, 217 Urinary tract, 174, 217 Urine, 6, 172, 194, 217 Urogenital, 187, 188, 217 Uterus, 104, 179, 182, 187, 198, 217 Uvea, 217 Uveitis, 40, 87, 217 V Vaccination, 26, 111, 217 Vaccine, 8, 12, 14, 21, 26, 105, 109, 122, 168, 207, 217 Vacuoles, 8, 201, 217 Vagina, 104, 149, 180, 217 Vaginal, 6, 9, 132, 148, 164, 216, 217 Vaginal Discharge, 216, 217 Vaginitis, 7, 148, 217 Vaginosis, 7, 9, 217 Varicella, 74, 217 Vascular, 4, 25, 59, 103, 192, 217 Vasculitis, 25, 217 Vector, 30, 193, 216, 217 Vein, 193, 200, 202, 210, 217, 218 Venereal, 7, 34, 77, 83, 90, 101, 104, 109, 110, 117, 119, 152, 214, 216, 218, 219 Venous, 170, 206, 218, 219 Venous Thrombosis, 218, 219 Ventricle, 169, 184, 190, 191, 207, 214, 218 Ventricular, 103, 218 Venules, 173, 218 Vertebrae, 212, 218 Vestibular, 4, 218 Vestibular Nerve, 218 Vestibule, 193, 218 Vestibulocochlear Nerve, 61, 176, 215, 218 Vestibulocochlear Nerve Diseases, 215, 218 Veterinary Medicine, 139, 218 Vibrio, 175, 218 Vibrio cholerae, 175, 218 Viral, 16, 17, 111, 183, 187, 201, 216, 218, 219 Viral Load, 16, 218 Virulence, 21, 23, 27, 103, 110, 171, 214, 216, 218 Virulent, 8, 103, 105, 109, 110, 218 Visceral, 171, 195, 219 Vitro, 8, 25, 110, 219 Vivo, 8, 219 W Walkers, 29, 219 War, 16, 28, 90, 114, 115, 219

Index 231

Warfarin, 130, 219 Warts, 90, 116, 148, 190, 219 White blood cell, 169, 195, 196, 199, 204, 219 Womb, 217, 219 Wound Infection, 27, 219 X Xenograft, 169, 219

X-ray, 27, 178, 186, 200, 208, 210, 219 Y Yaws, 83, 104, 106, 116, 216, 219 Yeasts, 186, 203, 219 Z Zoster, 74, 219 Zygote, 178, 219 Zymogen, 206, 219

232 Syphilis

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