Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
Clin Infect Dis. 2011 Dec;53(11):1092-9. doi: 10.1093/cid/cir671. Epub 2011 Oct 12.
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.
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.
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).
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.
梅毒治疗后需要进行血清学监测。我们比较了治疗早期（即一期、二期或早期潜伏）梅毒后血清学反应相关的因素。
我们对美国和马达加斯加进行的一项前瞻性、随机梅毒试验的数据进行了二次分析。2000-2009 年间，招募了年龄≥18 岁的、患有早期梅毒的人类免疫缺陷病毒（HIV）阴性参与者。基线和治疗后 3 个月及 6 个月时进行血清学检测。6 个月时，血清学治愈定义为快速血浆反应素（RPR）阴性或滴度较基线下降≥4 倍，血清固定定义为滴度较基线下降≤2 倍或持续存在但不符合治疗失败标准的滴度。
465 名参与者中有数据，其中 369 名（79%）实现了血清学治愈，96 名（21%）为血清固定。在单变量分析中，血清学治愈与年龄较小、性伴侣较少、基线 RPR 滴度较高和早期梅毒分期有关（P≤0.008）。与治疗后吉海反应的相关性较弱（P=0.08）。多变量分析显示，基线滴度的对数与梅毒分期之间存在交互作用，其中一期梅毒（调整后的比值比[OR]，1 个单位对数（2）滴度变化，1.83；95%置信区间[CI]，1.25-2.70）、二期梅毒（AOR，3.15；95% CI，2.14-4.65）和早期潜伏梅毒（AOR，1.86；95% CI，1.44-2.40）参与者的治愈几率与滴度增加相关。
早期梅毒治疗后 6 个月的血清学治愈与年龄、性伴侣数量、吉海反应以及梅毒分期和基线 RPR 滴度之间的相互作用有关。
