Correlation Between Histopathological Findings, CD4 Counts, and Treponeme Quantity in Microscopic Sections and Secondary Syphilis in HIV Positive Individuals


  • Mohammad Manzoor Pathology Department, Bacha Khan Medical College Mardan
  • Afreenish Amin Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar
  • Saman Hussain Pathology, Northwest School of Medicine, Peshawar
  • Rabeea Zia Pakistan Kidney and Liver Hospital (PKLI), Lahore
  • Adnan Sarwar Pathology, Pak International Medical College, Peshawar.
  • Muhammad Mahtab Shabir Medical Unit-II, District Headquarter Teaching Hospital Dera Ghazi Khan
  • Inam-u llah Department of Food Science, The University of Haripur, KPK, Pakistan
  • Hina Mir Department of Biochemistry, Shaheed Benazir Bhutto Women University, Peshawar
  • Sudhair Abbas Bangash Faculty of Life Science, Department of Pharmacy, Sarhad University of Science and Information Technology, Peshawar
  • FAres Muthanna Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat, 80160, Thailand



Infectiousagents,Warthin–Starrystain, HIV,immune-histochemistry, Syphilis


Syphilis is not common, although HIV-infected people are far more likely to be infected than the general population. This may be caused by weakened cellular immunity due to HIV infection. This study aimed to find out the correlation between CD4 concentration and T. Pallidum occurrence. Methods: A assessment of a single institution identified ten patients with secondary syphilis diagnosed through a skin biopsy, positive syphilis serology, and high CD4 levels. There were 14 samples obtained from 13 individuals. Immunohistochemistry (IHC) was used to detect the presence of treponemes and CD4 levels in skin samples. These findings have also been compared with results obtained from detecting T. Pallidum by IHC in silver stain sections (Warthin-Starry). A comparison of the histological characteristics of each sample has also been made. IHC was used to determine the number of treponemes on the samples. Results: Silver stain had a sensitivity of 9 percent whereas IHC detected the treponemes at 64 percent. (p-value of 0.04). Spirochetes high incidence found only in people with less than 250 cells/ml of CD4 (>100 per 10 HPF). Conclusions: The utmost persistent histological outcome was low to highlympho-plasmocytic infiltration. However, this research did show that a high spirochete count is associated with a low CD4 count (less than 250 cells/ml). In comparison to Warthin-Starry staining results, IHC staining for T. palidum has shown superior results.


Arroll, T. W., Centurion-Lara, A., Lukehart, S. A., Van Voorhis, W. C. J. I., & immunity. (1999). T-cell responses to Treponema pallidum subsp. pallidum antigens during the course of experimental syphilis infection. 67(9), 4757-4763.

Buchacz, K., Klausner, J. D., Kerndt, P. R., Shouse, R. L., Onorato, I., McElroy, P. D., . . . Coye, F. J. J. J. o. A. I. D. S. (2008). HIV incidence among men diagnosed with early syphilis in Atlanta, San Francisco, and Los Angeles, 2004 to 2005. 47(2), 234-240.

Carlson, J. A., Dabiri, G., Cribier, B., & Sell, S. J. T. A. j. o. d. (2011). The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity. 33(5), 433.

Ganesan, A., Fieberg, A., Agan, B. K., Lalani, T., Landrum, M. L., Wortmann, G., . . . diseases, I. D. C. R. P. H. W. G. J. S. t. (2012). Results of a 25 year longitudinal analysis of the serologic incidence of syphilis in a cohort of HIV infected patients with unrestricted access to care. 39(6).

Hartman, D. J., & Owens, S. R. J. A. j. o. c. p. (2012). Are routine ancillary stains required to diagnose Helicobacter infection in gastric biopsy specimens? An institutional quality assurance review. 137(2), 255-260.

Hoang, M. P., High, W. A., & Molberg, K. H. J. J. o. c. p. (2004). Secondary syphilis: a histologic and immunohistochemical evaluation. 31(9), 595-599.

Newbern, E. C., Anschuetz, G. L., Eberhart, M. G., Salmon, M. E., Brady, K. A., De Los Reyes, A., . . . Schwarz, D. F. J. A. j. o. p. h. (2013). Adolescent sexually transmitted infections and risk for subsequent HIV. 103(10), 1874-1881.

Patton, M. E., Su, J. R., Nelson, R., Weinstock, H. J. M. M., & report, m. w. (2014). Primary and secondary syphilis-United States, 2005-2013. 63(18), 402.

Røttingen, J.-A., Cameron, D. W., & Garnett, G. P. J. S. t. d. (2001). A Systematic Review of the Epidemiologie Interactions Between Classic Sexually Transmitted Diseases and HIV: How Much Really Is Known? , 579-597.

Salazar, J. C., Cruz, A. R., Pope, C. D., Valderrama, L., Trujillo, R., Saravia, N. G., & Radolf, J. D. J. T. J. o. i. d. (2007). Treponema pallidum elicits innate and adaptive cellular immune responses in skin and blood during secondary syphilis: a flow-cytometric analysis. 195(6), 879-887.



DOI: 10.54393/pbmj.v5i1.320
Published: 2022-01-31

How to Cite

Manzoor, M., Amin, A., Hussain, S., Zia, R., Sarwar, A., Shabir, M. M., llah, I.- u, Mir, H., Bangash, S. A., & Muthanna, F. (2022). Correlation Between Histopathological Findings, CD4 Counts, and Treponeme Quantity in Microscopic Sections and Secondary Syphilis in HIV Positive Individuals. Pakistan BioMedical Journal, 5(1), 253–256.



Original Article


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