title: Treatment and outcomes of polymerase chain reaction-confirmed early syphilis.
abstract: Background Syphilis is resurgent among gay and bisexual men (GBM) despite effective treatment and widely available diagnostic serology. The polymerase chain reaction assay for Treponema pallidum (TP-PCR) is available, but little is known about the clinical features and outcomes for patients testing positive by TP-PCR.
  
  
  METHODS
  Clinical data were collected from four medical practices for patients recording a positive TP-PCR result between 2004 and 2011. Demographic, serological, treatment and reinfection details were obtained. Results were stratified by HIV status and whether treatment conformed to international guidelines.
  
  
  RESULTS
  220 patients were positive for TP-PCR, of whom 92% were GBM. Seventeen (8.1%) were positive by TP-PCR before seroconversion. Almost one-third (32.1%) received treatment beyond that recommended in guidelines, and this was associated with HIV status (40.3% HIV positive vs 22.4% HIV negative, P<0.01). All but one patient with adequate follow up achieved serological cure. There was no significant difference in time to serological cure between the groups receiving standard therapy or enhanced therapy (95 vs 108 days; P=0.67) or between HIV positive and negative patients (93 vs 104 days, P=0.06). Nineteen patients were reinfected during follow up.
  
  
  CONCLUSIONS
  TP-PCR aids early diagnosis of syphilis and may be reactive before conventional serological tests. Treatment outcomes for TP-PCR-positive early infection were excellent, but a significant proportion of patients received non-standard therapy. Expanded use of syphilis PCR testing in at-risk populations is recommended since early identification and treatment is likely to be important in controlling the current epidemic in GBM.
authors.affiliation: Kirketon Road Centre, PO Box 22, Kings Cross, NSW 1340, Australia.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Read
authors.affiliation: Sexual Health Program, The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Guy
authors.affiliation: Centre for Microbiology and Infectious Diseases - Public Health, Institute for Clinical Pathology and Medical Research, Pathology West, NSW 2145, Australia.
authors.forename: Neisha
authors.initials: N
authors.lastname: Jeoffreys
authors.affiliation: East Sydney Doctors, 102 Burton Street, Darlinghurst, NSW 2010, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Baker
authors.affiliation: Taylor Square Private Clinic, 393 Bourke Street, Darlinghurst, NSW 2010, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Shields
authors.affiliation: Sexual Health Program, The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia.
authors.forename: Basil
authors.initials: B
authors.lastname: Donovan