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Response to: A double-edged sword: does highly active antiretroviral therapy contribute to syphilis incidence by impairing immunity to Treponema pallidum?
  1. David V Glidden1,
  2. Kenneth Mayer2,
  3. Robert M Grant1
  1. 1 University of California, San Francisco, San Francisco, California, USA
  2. 2 Fenway Community Health Center, Boston, USA
  1. Correspondence to Dr David V Glidden, Epidemiology and Biostatistics, University of California, 550 16th Street, San Francisco, CA 94158, USA; David.Glidden{at}ucsf.edu

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The authors impute a biological mechanism to the high incidence of syphilis in men who have sex with men using antiretroviral pre-exposure prophylaxis (PrEP), when empiric data do not support the biological hypothesis, and behavioural explanations (ie, increased condomless sex and selection of higher risk partners) are supported by stronger evidence. Randomised double-blind trials of PrEP for HIV prevention1 provide a rigorous test of the author's hypothesis. The …

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