[Clinical analysis and study of immunological function in syphilis patients with seroresistance].
Li Jun,Wang Lin-Na,Zuo Ya-Gang,Liu Yong-Xin,Liu Xiu-Rong,Lei Yang,Zheng He-Yi
Zhonghua yi xue za zhi
OBJECTIVE:To investigate the relevant factors of seroresistance of syphilis by clinical analysis and study of immunological function. METHODS:The clinical data of 172 patients with syphilis were analyzed to observe the correlation of seroresistance with the factors including original titer of rapid plasma regain (RPR), disease course, and medication. Flow cytometry was used to analyze the proportions of T-lymphocyte subset and NK cells in the peripheral blood of 40 untreated syphilitic patients at various stages, 20 syphilitic patients whose serology turned negative after treatment, 20 serum resistance patients, and 18 healthy controls. RESULTS:The seroresistance rate was 8.7% in the primary syphilis patients (2/23), significantly lower than that of the latent syphilis patients (42.2%, 38/90, P = 0.001). The seroresistance rate of the patients treated with benzathine penicillin was 26.4% (42/159), significantly lower that of the patients treated with macrolides (76.9%, 10/13, P = 0.000). The proportion of CD8(+) T cells of the untreated syphilitic patients was (30% +/- 8%), significantly higher than that of the normal controls [(24% +/- 4%), P < 0.01]. The proportion of NK cells of the untreated syphilitic patients was (13% +/- 5%), significantly lower than that of the normal controls (16% +/- 6%, P < 0.05). The proportion of CD3(+) T cells of the patients whose serology turned negative after treatment was (71% +/- 7%), significantly higher than that of the normal controls (65% +/- 7%, P < 0.05). The proportion of CD8(+) T cells of the patients whose serology turned negative after treatment was (29% +/- 7%), significantly higher than that of the normal controls (24% +/- 4%, P < 0.01). There were not significant differences in the proportions of different cells among the patients with seroresistance, serological negative conversion, and normal controls. CONCLUSION:Syphilis patients with a high baseline RPR titer, a latent course and macrolide therapy are prone to be seroresistant. Whether the occurrence of serum resistance is related to the inhibition of cell-mediated immunity requires further exploration.
No improvement in serological response among serofast latent patients retreated with benzathine penicillin.
Ren Rong-Xin,Wang Lin-Na,Zheng He-Yi,Li Jun
International journal of STD & AIDS
Persistent non-treponemal titres after treatment are common among patients with latent syphilis. Although retreatment is often done in clinical practice, optimal management remains uncertain due to the paucity of data regarding serological response to retreatment and long-term outcomes. We compared the serological responses of serofast latent syphilis patients retreated with 7.2 million units of benzathine penicillin with the responses of patients who did not receive retreatment (control group). We retrospectively analysed the serological response to therapy following retreatment of 35 serofast latent syphilis patients at 12 months with benzathine penicillin 2.4 million units weekly for 3 weeks. In all, 74.3% (26/35) of the cases with latent syphilis who failed to achieve serological cure at 12 months after initial therapy achieved serological cure after retreatment and after an additional 12 months of follow-up. However, statistically similar serological cure rate was observed in 80.0% (28/35) of the control group (p > .05). Our findings illustrate no improvement in serological response among serofast latent patients retreated with three doses of benzathine penicillin.
10.1177/0956462415573677
Predictors of serological cure and Serofast State after treatment in HIV-negative persons with early syphilis.
Seña Arlene C,Wolff Mark,Martin David H,Behets Frieda,Van Damme Kathleen,Leone Peter,Langley Carol,McNeil Linda,Hook Edward W
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
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.
10.1093/cid/cir671
Incidence and Predictors of Serological Treatment Response in Early and Late Syphilis Among People Living With HIV.
Spagnuolo Vincenzo,Poli Andrea,Galli Laura,Nozza Silvia,Bossolasco Simona,Cernuschi Massimo,Maillard Myriam,Hasson Hamid,Gianotti Nicola,Guffanti Monica,Lazzarin Adriano,Castagna Antonella
Open forum infectious diseases
BACKGROUND:Few studies have investigated predictors of serological response to syphilis treatment in people living with HIV (PLWH). METHODS:This was a retrospective, longitudinal study on PLWH who were diagnosed with and treated for syphilis who had an assessable serological response between January 2004 and June 2016. Serological treatment response (TR) was defined as a ≥4-fold decline in rapid plasma reagin (RPR) titers or a reversion to nonreactive (if RPR ≤1:4 at diagnosis) 12 months after treatment for early syphilis and 24 months after treatment for late syphilis. Factors associated with a TR were assessed with multivariate Cox proportional hazard models for recurrent events. RESULTS:A total of 829 episodes of syphilis (686 early, 143 late) in 564 patients were recorded. TR was observed in 732 (88%) syphilis episodes. The proportion of TR differed between early and late syphilis (89% vs 83%, respectively; = .045). For early syphilis, TR was associated with a higher nadir CD4+ cell count (adjusted hazard ratio [AHR], 1.06; = .029), an RPR titer >1:32 at diagnosis (AHR, 1.26; = .009), secondary syphilis (AHR, 1.29; = .008), and cases of syphilis diagnosed in more recent calendar years (AHR, 1.36; < .0001). In late syphilis, TR was more likely to occur for first infections (AHR, 1.80; = .027), for episodes that occurred in more recent years (AHR, 1.62; = .007), and for RPR titers >1:32 at diagnosis (AHR, 2.04; = .002). TR was not associated with the type of treatment regimen in early and late syphilis. CONCLUSIONS:Higher RPR titers at diagnosis and a diagnosis of syphilis that was made in more recent years were associated with TR in early and late syphilis.
10.1093/ofid/ofy324
Factors associated with serological cure and the serofast state of HIV-negative patients with primary, secondary, latent, and tertiary syphilis.
PloS one
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.
10.1371/journal.pone.0070102
Time to Serological Cure and Associated Factors Among Syphilis Patients With and Without HIV in a Sexually Transmitted Infections Center, Thailand.
Atsawawaranunt Kamolthip,Kittiyaowamarn Rossaphorn,Phonrat Benjaluck,Kamolratanakul Supitcha,Kangvalpornroj Thanyanan,Dhitavat Jittima
Sexually transmitted diseases
BACKGROUND:Together with clinical correlation, nontreponemal titers are used to monitor treatment outcomes. Syphilis patients with HIV and without HIV coinfection were found to have different serological responses after treatment. This study aims to determine time to serological cure for treatment of syphilis and factors associated with it in patients with and without HIV. METHOD:A descriptive study of syphilis patients who visited Bangrak STIs Center between January 1, 2007, and December 31, 2016. Univariate analysis was done to determine factors associated with serological outcomes. Survival curve analysis and multivariate Cox regression analysis were applied to compare time to serological cure between patients with various characteristics. RESULTS:Of 497 syphilis patients, 62.1% had serological cure, 2.2% had nonresponse, 4.6% had treatment failure or reinfection, 9.9% had serofast status, and 21.2% were undetermined because of loss to follow-up. The time to serological cure was 110 days (95% confidence interval [CI], 59-163 days) and 102 days (95% CI, 94-110 days) among patients with HIV and without HIV, respectively (P = 0.162). Time to serological cure was significantly faster in early syphilis and baseline titer ≥1:32. After adjustment with the Cox regression model, patients with early syphilis were associated with serological cure with a hazard ratio of 1.75 (95% CI, 1.32-2.32). Time to serological cure among early syphilis patients was significantly longer in HIV-positive than HIV-negative patients (P = 0.002), whereas no difference was observed in late syphilis (P = 0.104). CONCLUSION:Early syphilis was associated with faster time to serological cure. HIV patients with early syphilis took longer time to reach serological cure than did HIV-negative patients, whereas no such a difference was observed in late syphilis.
10.1097/OLQ.0000000000001154
Predictors of serological cure after treatment in patients with early syphilis: A retrospective observational study in Thailand.
Indian journal of dermatology, venereology and leprology
BACKGROUND:Some patients with early syphilis who receive appropriate treatment do not reach a serological cure and have a persistent titer which does not meet the criteria for treatment failure (serofast state). AIMS:This retrospective study aimed to determine the prevalence of serological cure and the serofast state as well as the factors associated with serological cure after treatment of patients with early syphilis. METHODS:A serological cure was defined as occurring when there was a ≥4-fold decrease in nontreponemal titer, whereas patients with a ≥4-fold increase were considered as having either a treatment failure or reinfection. Nontreponemal titers that neither increased nor decreased ≥4-fold after treatment were considered to be in a serofast state. Seroreversion was defined as occurring when there was a negative test within 12 months of treatment. RESULTS:There were 179 patients with a mean age of 31.9 years; 174 (97.2%) were men, and 125 (70%) were HIV patients. Of the total, 174 (98%; 95% confidence interval 94.82-99.42%) patients achieved a serological cure, whereas five were in a serofast state 12 months after treatment. Those five serofast patients were all HIV-positive men, of which 4 (80%) had secondary-stage syphilis, a CD4 count ≤200 cells/μl and a titer <1:8. In a bivariate analysis, a serological cure was associated with a baseline Venereal Disease Research Laboratory >1:16 titers (P = 0.018), and a CD4 cell count >200 cells/μl in 6 months preceding treatment (P = 0.016). The median time to a serological cure was 96 days. Only 22 (12.3%) of the patients achieved seroreversion at 12 months after treatment. LIMITATIONS:A retrospective medical record review is likely to have a selection bias, and in our study, 196 (52%) patients were excluded due to missing information. CONCLUSIONS:Most patients with early syphilis who achieved a serological cure at 12 months after treatment had high baseline Venereal Disease Research Laboratory titers and CD4 cell counts. However, only 22 (12.3%) had a negative Venereal Disease Research Laboratory titer after 1 year of treatment.
10.4103/ijdvl.IJDVL_810_17