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Original Article
Transient aortitis documented by positron emission tomography in a case series of men and transgender women infected with syphilis
  1. Dvora Joseph Davey1,2,
  2. Noah Kojima3,
  3. Kelika A Konda3,4,
  4. Pawan Gupta3,
  5. Segundo R Leon4,
  6. Gino M Calvo4,
  7. Carlos F Caceres4,
  8. Jeffrey D Klausner1,2
  1. 1Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
  2. 2Division of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
  3. 3David Geffen School of Medicine, University of California, Los Angeles, California, USA
  4. 4Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
  1. Correspondence to Dr Dvora Joseph Davey, University of California, Los Angeles, Fielding School of Public Health, 10833 Le Conte Ave, Los Angeles, CA 90095, USA; dvoradavey{at}gmail.com

Abstract

Objectives Syphilis infection persists globally contributing to preventable and treatable morbidity and mortality. How extensive early syphilis disseminates is unknown. To better understand the relationship between early syphilis infection and inflammation over time, our study enrolled six individuals recently infected with syphilis for sequential positron emission tomography (PET) scans.

Methods We evaluated a case series of six individuals with high syphilis titres (two secondary, two early latent and two latent, unknown duration, but with high titre) who received sequential PET scans to assess inflammation over time and its response to treatment.

Results At time of PET scan, four of the six individuals were co-infected with HIV. One of the four was not on antiretroviral therapy and three of the four were not virally suppressed (viral load of >400 copies/mL). Baseline rapid plasma reagin (RPR) titres ranged from 1:64 to 1:256 (four of the six participants had prior non-reactive RPR results). Five of the six participants had mild to intense hypermetabolic PET scan activity consistent with cervical (n=5), axillary (n=4), inguinal (n=5) and retroperitoneal (n=1) adenopathy. Mild hypermetabolic activity in the thoracic aortic wall, suggesting aortitis, was present among the same five participants and resolved within 30 days for four of the five participants and 60 days for the other participant. However, widespread lymphadenopathy remained present in PET scans up to 3 months following treatment in two participants. We did not find any abnormal PET scan activity of the central nervous system.

Conclusion We found abnormal aortic wall PET scan activity suggesting aortitis to be common in a case series of patients with early syphilis. In research settings, PET scans may be a sensitive tool to monitor inflammation associated with syphilis.

  • Positron-Emission Tomography
  • Syphilis
  • Aortitis
  • Transgender Persons
  • Syphilis Cardiovascular

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Footnotes

  • Contributors DJD did the analyses and data collection and wrote the first and final draft. NK did the literature review and data analysis, wrote sections of the paper and approved final version. KAK was the study manager, did the analysis and edited several versions of the manuscript. PG was the clinician on the study, who did the PET scan review and reviewed all analyses, edited sections and approved the final draft. SRL worked on the study, reviewed analyses, wrote sections and edited/approved the final version. GMC worked on the study, reviewed analyses, wrote sections and edited/approved the final version. CFC was the PI on the study, developed the substudy, supported analyses, wrote sections and approved the final draft. JDK was the PI on the study, developed the substudy, supported analyses, wrote sections and approved the final draft.

  • Competing interests None declared.

  • Ethics approval Universidad Peruana Cayetano Heredia.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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