Factors associated with syphilis treatment failure and reinfection: a longitudinal cohort study in Shenzhen, China

Abstract

BackgroundThe treatment failure and reinfection rates among syphilis patients are high, and relevant studies in China are limited. The aim of this study was to detect the rates of treatment failure and reinfection after syphilis treatment and to explore the potential associated factors.MethodsWe conducted a longitudinal cohort study in a sexually transmitted disease clinic, the Department of Dermatology and Venereology in Nanshan Center for Chronic Disease Control. Serological testing was performed at baseline and throughout the 2-year follow-up for syphilis patients. To identify potential predictors of treatment outcomes, multivariate logistics analyses were utilized to compare the demographic and clinical characteristics of patients with serological failure/reinfection to those with serological cure/serofast.ResultsFrom June 2011 to June 2016, a total of 1133 patients were screened for syphilis. Among the 770 patients who completed the 2-year follow-up, 510 first-diagnosed patients were included in the final analysis. Multivariate logistics analysis revealed the stage of syphilis (secondary syphilis VS. primary syphilis: adjusted odds ratio, 3.50; 95% confidence interval, 1.11-15.47; p = 0.04), HIV status (positive VS. negative: adjusted odds ratio, 3.06; 95% confidence interval, 1.15-8.04; p = 0.02) and frequency of condom use (always use VS. never use: adjusted odds ratio, 0.28; 95% confidence interval 0.08-0.75; p = 0.02) were significantly associated with the serological outcome.ConclusionsThe clinical implications of our findings suggest that it is very important to perform regular clinical and serologic evaluations after treatment. Health counseling and safety education on sex activity should be intensified among HIV-infected patients and secondary syphilis patients after treatment.

Predictors of Seronegative Conversion After Centralized Management of Syphilis Patients in Shenzhen, China

“…We also found that patients with primary syphilis were more likely to experience TRUST seronegative conversion than those who were receiving adequate treatment before enrollment and more so than patients with secondary and latent syphilis. The results of the current study were consistent with a previous observation that patients with secondary syphilis were more likely to experience treatment failure than those with primary syphilis ( 25 ). In addition, Tong et al reported that the rate of serological cure decreased in the order of primary, secondary, latent, and tertiary syphilis ( 22 ).…”

Predictors of serofast state after treatment for early syphilis in HIV‐infected patients

“…Given the possibility of a slower titre decline, a follow‐up for at least 12 months in HIV‐coinfected patients seems reasonable. A history of previous syphilis infection, as well as lower baseline RPR titres are known risk factors for serofast state after treatment [8,26–29]. These findings were confirmed in our study.…”

Recurrent ocular syphilis in a patient living with HIV

“…14 A longer duration of therapy may be required for patients with HIV and other forms of immunosuppression. 15,16…”