AFRO-NETS> "Syphilis shocker" (NOW Magazine, July 27/2000)

[Colman Jones <mail@colman.net>]

"Syphilis shocker" (NOW Magazine, July 27/2000)
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NOW Magazine 
Toronto, Canada - July 27/2000

SYPHILIS SHOCKER
Is there AIDS clue in "negative" tests that come back positive?

By Colman Jones

Ontario health officials have made a shocking discovery that threat-
ens to blow the roof off conventional thinking about a dangerous 
sexually-transmitted infection -- syphilis -- and how to test for it 
among people at risk for AIDS.

In a presentation at this year's meeting of the American Society of 
Microbiology, Neal denHollander, who directs research at the Public 
Health Laboratory of Ontario, showed how a new type of syphilis test 
found otherwise undetected cases in nearly five per cent of samples 
from STD clinics including the Hassle Free Clinic on Church.

These were positive results in samples that showed up negative in the 
regular screening test.

The significance of this might well be that there are many people 
walking around today who are carrying the STD and don't know it. But 
more than that, the finding may inch us much closer to answering the 
question that has preoccupied me for several years now -- does syphi-
lis play an important and possibly necessary role in the development 
of AIDS itself?

The new technology that allows us to find the formerly unfindable STD 
is called the Trep-Chek. To see how well the new test performed 
against the regular ones, denHollander and colleagues took 557 recent 
blood specimens, mostly from Hassle Free's routine syphilis submis-
sions -- all had come back negative in the standard screening test 
(called the VDRL).

To their surprise, they found 27 registered positive.

The study, which has taken the local AIDS community by surprise, re-
vives concerns first sounded over 10 years ago by then-chief provin-
cial serologist Bob Notenboom. With the help of Douglas MacFadden, 
director of the HIV Clinic at Toronto Hospital's Western Division, 
and local bookstore owner and AIDS expert John Scythes, Notenboom and 
his officials documented unexplainable irregularities in syphilis 
testing among people with HIV.

Thorny question

With the aid of this more sophisticated biotechnology, denHollander 
now has taken up the issue again. He stresses that the standard meth-
ods used to screen for syphilis are "clearly under-sensitive."

How much of a concern is this diagnostic gap? That all depends on how 
dangerous one considers untreated syphilis to be.

AIDS experts readily acknowledge the high correlation between being 
HIV-positive and having had syphilis, but only insofar as the sores 
produced by syphilis allow HIV to enter the body more easily. How-
ever, some theorists argue that untreated or inadequately treated 
syphilis may be a factor in the development of AIDS -- especially as 
new evidence suggests bacterial infections can "wake up" an otherwise 
latent, inactive HIV infection.

Indeed, emerging research into the immune response in the later 
stages of syphilis suggests there may be much more going on between 
syphilis and HIV than was previously thought. Recent findings from 
veteran Polish syphilis researcher Jadwiga Podwinska point to pro-
nounced immune irregularities once the disease has reached the latent 
(hidden) stage.

Among HIV primary-care physicians, the surprising new findings only 
confirm their own doubts about syphilis tests. "Compared to other 
tests, they tend to be less reliable," says John Goodhew. "I compen-
sate for that by doing syphilis tests on everybody every year."

But no one knows how well the syphilis tests Goodhew is using really 
work. Indeed, Notenboom found AIDS patients with a past history of 
syphilis who seemed to lose their normally lifelong specific antibod-
ies against syphilis, while antibodies against other infections re-
main. "It is possible," he says, "to have syphilis, and yet all the 
tests are negative."

Could untreated chronic syphilis be making a lot of people sick, es-
pecially those with HIV? It's a concern I voice to Bill Cameron from 
the University of Ottawa, one of Canada's leading AIDS authorities.

"I agree with you," he admits from Oxford University in England where 
he is a visiting research scientist. "I would be happy to see a 
large-scale evaluation of these newer and better tests."

--
Colman Jones
mailto:mail@colman.net

NOW - Jul 27 - Aug 2, 2000 - Vol. 19 No. 48
http://www.nowtoronto.com/issues/2000-07-27/news4.html 

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