HIV and ID Observations

October 8th, 2024

Why We Have Antibiotic Shortages and Price Hikes — And What One Very Enterprising Doctor Did in Response

At the start of our weekly case conference, we get announcements from one of our ID pharmacists. New drug approvals, hospital policies, updated guidelines — that kind of thing. But over the last decade or so, the most common topic they’ll comment on is the latest important antibiotic shortage. For those not in medicine, you […]

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June 9th, 2024

The Mysteries and Challenges of the RPR — and a Proposed Clinical Trial

Last week, we had a real treat for our weekly ID/HIV clinical conference — a review of controversies in the management of syphilis in adults by Dr. Khalil Ghanem, from Johns Hopkins. He’s a well-known expert in the field of sexually transmitted infections, syphilis in particular. A highlight of the talk was his dismantling of a […]

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January 13th, 2020

Diagnostic Tests for Syphilis Continue to Perplex Even the Experts: An Unanswerable Question in Infectious Diseases

Here’s a tricky clinical scenario: An elderly person with cognitive decline or some other non-specific neurologic symptom sees a clinician. Clinician sends a syphilis screen with a T. pallidum enzyme immunoassay (TP-EIA), which returns positive. Lab runs a confirmatory test — a T. pallidum particle agglutination test (TP-PA), or similar, which also returns positive. The lab […]

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June 18th, 2012

ID Learning Unit — Serologic Tests for Syphilis

Diagnosing syphilis is tricky for lots of reasons, including: The protean disease manifestations, many of which were best described in older medical literature — and hence not known to people who don’t read words on paper (vs a screen) very often. You can’t visualize the bug (Treponema pallidum), unless you happen to have a darkfield microscope […]

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December 6th, 2010

Tough Diagnoses: Neurosyphilis, Then and Now

During Thanksgiving, my brother-in-law — who is a professional musician and also a passionate history buff — gave me a scholarly paper to review on the strange death of the famous American explorer Meriwether Lewis, of “Lewis and Clark” fame. The bottom line?  Lewis may well have had neurosyphilis — at least that’s the premise of the […]

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