HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium.
Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa.
Sex Transm Infect. 2018 May;94(3):180-186. doi: 10.1136/sextrans-2017-053312. Epub 2017 Oct 11.
We aimed to asses if there are differences in the clinical presentation and immune response of repeat as compared with initial syphilis.
Prospective study: we prospectively recruited all patients with a new diagnosis of syphilis and tested their plasma for a range of cytochemokines and rapid plasma reagin (RPR) at baseline pretreatment and 6 months following therapy. Retrospective study: we compared RPR assay response kinetics between initial and repeat syphilis in persons attending our HIV/STI clinic from 1993 to 2016.
Prospective study: a total of 91 individuals, 36 with initial syphilis and 55 with repeat syphilis, were included in the study. At baseline visit, those with initial syphilis were more likely to be symptomatic and have higher levels of interleukin-10 than repeaters. At baseline, median RPR titres were higher in the repeat than the initial infection groups. Repeaters were less likely than those with initial infections to serorevert to a negative RPR and be serofast (<4-fold RPR titre decline) at 6 months.Retrospective study: syphilis was diagnosed in 1027/43 870 individuals tested. At diagnosis, repeaters had higher RPR titres and a stepwise increase in RPR titre with number of syphilis episodes. They had a different RPR test response kinetic: they were less likely to be serofast and to serorevert than initial syphilis at 6 and 12 months. No individuals with four or more previous episodes of syphilis seroreverted.
Repeat syphilis has a different clinical presentation and immunological response to initial infection.
本研究旨在评估复发性梅毒与初发性梅毒相比，在临床表现和免疫反应方面是否存在差异。
前瞻性研究：我们前瞻性招募了所有新诊断为梅毒的患者，并在基线治疗前和治疗后 6 个月检测了他们的血浆中一系列细胞趋化因子和快速血浆反应素（RPR）。回顾性研究：我们比较了从 1993 年到 2016 年在我们的 HIV/性传播感染诊所就诊的初发性和复发性梅毒患者的 RPR 检测反应动力学。
前瞻性研究：共纳入 91 例患者，其中 36 例为初发性梅毒，55 例为复发性梅毒。在基线就诊时，初发性梅毒患者更有可能出现症状，且白细胞介素-10 水平高于复发性梅毒患者。基线时，复发性梅毒患者的 RPR 滴度中位数高于初发性感染组。与初发性感染相比，复发性梅毒患者在 6 个月时更不可能血清学转阴且成为血清固定（RPR 滴度下降<4 倍）。回顾性研究：在 43870 例接受检测的个体中，诊断出梅毒 1027 例。在诊断时，复发性梅毒患者的 RPR 滴度更高，且随着梅毒发作次数的增加，RPR 滴度呈逐步升高。他们的 RPR 检测反应动力学不同：与初发性梅毒相比，他们在 6 个月和 12 个月时更不可能成为血清固定且血清学转阴。没有 4 次或更多次既往梅毒发作的患者出现血清学转阴。
复发性梅毒的临床表现和免疫反应与初发性感染不同。
