Leeyaphan Charussri, Punyaratabandhu Preawphan, Jiamton Sukhum, Junsuwan Natchaya, Chirachanakul Pornchai, Chanyachailert Pattriya, Omcharoen Viboon
Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
Indian J Dermatol Venereol Leprol. 2019 Mar-Apr;85(2):235. doi: 10.4103/ijdvl.IJDVL_810_17.
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).
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.
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.
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.
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.
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.
一些接受适当治疗的早期梅毒患者未实现血清学治愈，其滴度持续存在且不符合治疗失败标准（血清固定状态）。
这项回顾性研究旨在确定早期梅毒患者治疗后血清学治愈和血清固定状态的患病率以及与血清学治愈相关的因素。
血清学治愈定义为非梅毒螺旋体滴度下降≥4倍，而滴度增加≥4倍的患者被视为治疗失败或再次感染。治疗后非梅毒螺旋体滴度既未增加也未下降≥4倍的患者被视为处于血清固定状态。血清学转阴定义为治疗后12个月内检测结果为阴性。
共有179例患者，平均年龄31.9岁；174例（97.2%）为男性，125例（70%）为HIV患者。其中，174例（98%；95%置信区间94.82 - 99.42%）患者实现了血清学治愈，而5例在治疗后12个月处于血清固定状态。这5例血清固定患者均为HIV阳性男性，其中4例（80%）患有二期梅毒，CD4细胞计数≤200个/μl且滴度<1:8。在二元分析中，血清学治愈与基线性病研究实验室滴度>1:16（P = 0.018）以及治疗前6个月CD4细胞计数>200个/μl相关（P = 0.016）。血清学治愈的中位时间为96天。仅22例（12.3%）患者在治疗后12个月实现了血清学转阴。
回顾性病历审查可能存在选择偏倚，在我们的研究中，196例（52%）患者因信息缺失被排除。
大多数在治疗后12个月实现血清学治愈的早期梅毒患者基线性病研究实验室滴度和CD4细胞计数较高。然而，治疗1年后仅有22例（12.3%）患者的性病研究实验室滴度为阴性。
