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Cited by 132Syphilis Diagnosis and TreatmentHistorical Medical Research and TreatmentsVector-borne infectious diseases

Predictors of serological cure and serofast state after treatment in HIV-negative persons with early syphilis.

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Sena, A. C., Wolff, M., Martin, D. H., Behets, F., Van Damme, K., Leone, P., Langley, C., McNeil, L. +1 more·2011·Clinical Infectious Diseases
DOI 10.1093/cid/cir671PMC PMC3205200
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Abstract

BACKGROUND: Syphilis management requires serological monitoring after therapy. We compared factors associated with serological response after treatment of early (ie, primary, secondary, or early latent) syphilis. METHODS: We performed secondary analyses of data from a prospective, randomized syphilis trial conducted in the United States and Madagascar. Human immunodeficiency virus (HIV)-negative participants aged ≥ 18 years with early syphilis were enrolled from 2000-2009. Serological testing was performed at baseline and at 3 and 6 months after treatment. At 6 months, serological cure was defined as a negative rapid plasma reagin (RPR) test or a ≥4-fold decreased titer, and serofast status was defined as a ≤ 2-fold decreased titer or persistent titers that did not meet criteria for treatment failure. RESULTS: Data were available from 465 participants, of whom 369 (79%) achieved serological cure and 96 (21%) were serofast. In bivariate analysis, serological cure was associated with younger age, fewer sex partners, higher baseline RPR titers, and earlier syphilis stage (P ≤ .008). There was a less significant association with Jarisch-Herxheimer reaction after treatment (P = .08). Multivariate analysis revealed interactions between log-transformed baseline titer with syphilis stage, in which the likelihood of cure was associated with increased titers among participants with primary syphilis (adjusted odds ratio [AOR] for 1 unit change in log(2) titer, 1.83; 95% confidence interval [CI], 1.25-2.70), secondary syphilis (AOR, 3.15; 95% CI, 2.14-4.65), and early latent syphilis (AOR, 1.86; 95% CI, 1.44-2.40). CONCLUSIONS: Serological cure at 6 months after early syphilis treatment is associated with age, number of sex partners, Jarisch-Herxheimer reaction, and an interaction between syphilis stage and baseline RPR titer.

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  • Nontreponemal test titers might decrease more slowly for persons previously treated for syphilis.

    “In addition, nontreponemal test titers might decrease more slowly for persons previously treated for syphilis (594,595).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [595]

    In Characteristics Associated With Serological Cure (page unavailable), the paper reports that a history of syphilis was not significantly associated with serological cure; the Discussion likewise says it found no association between history of syphilis and serological response. It mentions a prior study finding less seroreversion after repeat infection, but that is not a finding that titers decrease more slowly in previously treated persons. (LLM, conf=0.82)

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  • In some patients, titres may not decrease to become non-reactive after treatment and may remain persistently reactive (serofast state), most common in persons treated one or more years after infection.

    “However, in some patients, titres may not decrease to become non-reactive after treatment and may remain persistently reactive (44). This is known as a serofast state and is most common in persons treated one or more years after infection (44, 45).”

    From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as [44]

    The Abstract and Study Outcomes describe patients whose nontreponemal titres remain reactive after treatment, but define serofast status by a limited change in titre, not simply by failure to become non-reactive. The Discussion associates earlier-stage infection with greater serological cure; it does not establish that serofast status is most common in people treated one or more years after infection. Page numbers are unavailable in our copy. (LLM, conf=0.87)

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Authors
Sena, A. C., Wolff, M., Martin, D. H., Behets, F., Van Damme, K., Leone, P., Langley, C., McNeil, L., & Hook, E. W.
Affiliations
  • Emmes (United States) (US)
  • Louisiana State University (US)
  • University of North Carolina at Chapel Hill (US)
  • Indiana University Indianapolis (US)
  • Family Health International 360 (US)
  • University of Alabama at Birmingham (US)
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2011-10-12
Volume
53
Issue
11
Pages
1092-1099
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1093/cid/cir671
PMC
PMC3205200
OpenAlex
W2128993328
Cited by
132
References
24
Citations by year
2026: 8 · 2025: 14 · 2024: 8 · 2023: 11 · 2022: 7 · 2021: 12 · 2020: 16 · 2019: 6 · 2018: 6 · 2017: 6 · 2016: 5 · 2015: 12 · 2014: 8 · 2013: 7 · 2012: 4
FWCI
4.58
Type
journal article
Language
en
Open access
Locations
  • Clinical Infectious Diseases (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Pfizer
  • U.S. Public Health Service (N01 A1 75329)
Topics
  • Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Historical Medical Research and Treatments
  • Life Sciences › Immunology and Microbiology › Parasitology › Vector-borne infectious diseases
Keywords
early syphilis, serological cure, syphilis stages, Jarisch-Herxheimer reaction, HIV-negative patients, predictors of treatment response
MeSH terms
Adolescent, Adult, Female, Humans, Madagascar, Male, Middle Aged, Prognosis, Prospective Studies, Reagins, Serologic Tests, Syphilis, United States, Treatment Outcome, Drug Monitoring, Young Adult

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