title: Factors associated with serological cure and the serofast state of HIV-negative patients with primary, secondary, latent, and tertiary syphilis.
abstract: 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.
authors.affiliation: Center of Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China.
authors.forename: Man-Li
authors.initials: ML
authors.lastname: Tong
authors.forename: Li-Rong
authors.initials: LR
authors.lastname: Lin
authors.forename: Gui-Li
authors.initials: GL
authors.lastname: Liu
authors.forename: Hui-Lin
authors.initials: HL
authors.lastname: Zhang
authors.forename: Yan-Li
authors.initials: YL
authors.lastname: Zeng
authors.forename: Wei-Hong
authors.initials: WH
authors.lastname: Zheng
authors.forename: Li-Li
authors.initials: LL
authors.lastname: Liu
authors.forename: Tian-Ci
authors.initials: TC
authors.lastname: Yang
mesh_terms: D000328:Adult; D017963:Azithromycin / Q000627:therapeutic use; D015331:Cohort Studies; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000382:microbiology; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D015999:Multivariate Analysis; D010400:Penicillin G / Q000627:therapeutic use; D011935:Reagins / Q000097:blood; D013587:Syphilis / Q000097:blood* / Q000188:drug therapy* / Q000821:virology; D013588:Syphilis Serodiagnosis; D013592:Syphilis, Latent / Q000097:blood / Q000188:drug therapy / Q000821:virology; D014210:Treponema pallidum / Q000276:immunology; D055815:Young Adult
chemical_list: D007075:Immunoglobulin M; D011935:Reagins; D017963:Azithromycin; D004318:Doxycycline; D010400:Penicillin G
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