Factors associated with serological cure and the serofast state of HIV-negative patients with primary, secondary, latent, and tertiary syphilis.
Open accessAbstract
BACKGROUND: Some syphilis patients remain in a serologically active state after the recommended therapy. We currently know too little about the characteristics of this serological response. METHODS: We conducted a cohort study using the clinical database from Zhongshan Hospital, Medical College of Xiamen. In total, 1,327 HIV-negative patients with primary, secondary, latent, and tertiary syphilis were enrolled. Bivariate and multivariate analyses were utilised to identify factors associated with a serological cure and serofast state in syphilis patients one year after therapy. Chi-square tests were used to determine the differences in the serological cure rate across different therapy time points. RESULTS: One year after the recommended therapy, 870 patients achieved a serological cure, and 457 patients (34.4%) remained in the serofast state. The serological cure rate increased only within the first 6 months. The bivariate analysis indicated that male or younger patients had a higher likelihood of a serological cure than female or older patients. Having a baseline titre ≤ 1∶2 or ≥ 1∶64 was associated with an increased likelihood of a serological cure. The serological cure rate decreased for the different disease stages in the order of primary, secondary, latent, and tertiary syphilis. A distinction should be drawn between early and late syphilis. The multivariate analysis indicated that a serological cure was significantly associated with the disease phase, gender, age, and baseline rapid plasma reagin (RPR) titre. CONCLUSIONS: The serofast state is common in clinical work. After one year of the recommended therapy, quite a few syphilis patients remained RPR positive. The primary endpoint of the study indicated that disease phase, gender, age and baseline RPR titre were crucial factors associated with a serological cure.
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Serologic response to treatment appears associated with initial nontreponemal antibody titers; titers <1:8 are less likely to decline fourfold than higher titers.
“initial nontreponemal antibody titers (titers <1:8 are less likely to decline fourfold than higher titers)”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [598]
The Results section, “Serological Responses for Different Baseline RPR Titres,” confirms that response was associated with initial titre but contradicts the claimed direction: patients with a 1:1 titre had an 80.1% serological cure rate, compared with 60.8% for titres ≥1:32. The lowest reported cure rate was for a titre of 1:8, not for titres below 1:8. (LLM, conf=0.90)
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Experimental — accuracy not yet measuredSerologic response to treatment appears associated with syphilis stage; earlier stages are more likely to decrease fourfold and become nonreactive.
“Serologic response to treatment appears to be associated with multiple factors, including the person’s syphilis stage (earlier stages are more likely to decrease fourfold and become nonreactive)”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [598]
The Discussion (page unavailable) reports that serological cure decreased in the order primary, secondary, latent, then tertiary syphilis, supporting the association with stage. The Introduction (page unavailable) defines cure as a nontreponemal titre becoming negative **or** decreasing fourfold; it does not show that earlier-stage patients were more likely to achieve both outcomes together. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSerologic response to treatment appears associated with age; titers among older patients might be less likely to decrease fourfold than those of younger patients.
“age (titers among older patients might be less likely to decrease fourfold than those of younger patients) (596–598).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [598]
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References 43 · Cited by 99
- Authors
- Tong, M.-L., Lin, L.-R., Liu, G.-L., Zhang, H.-L., Zeng, Y.-L., Zheng, W.-H., Liu, L.-L., & Yang, T.-C.
- Affiliations
- Xiamen University (CN)
- Fujian Medical University (CN)
- Corresponding author
- Liu, Li-Li
- Yang, Tian-Ci
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-07-23
- Volume
- 8
- Issue
- 7
- Pages
- e70102
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3720935
- OpenAlex
- W2055460971
- Cited by
- 99
- References
- 43
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 9 · 2023: 8 · 2022: 9 · 2021: 9 · 2020: 8 · 2019: 7 · 2018: 5 · 2017: 5 · 2016: 8 · 2015: 8 · 2014: 6 · 2013: 1
- FWCI
- 5.34
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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
- syphilis, serological cure, HIV-negative patients, primary syphilis, secondary syphilis, latent syphilis, tertiary syphilis, disease stage, age and gender, syphilis treatment outcomes
- MeSH terms
- Adult, Doxycycline, Female, Humans, Immunoglobulin M, Male, Penicillin G, Reagins, Syphilis, Syphilis Serodiagnosis, Syphilis, Latent, Treponema pallidum, Cohort Studies, HIV Infections, Multivariate Analysis, Azithromycin, Young Adult
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