Article Text

O11.2 Repeat syphilis is associated with an altered immune profile
  1. Chris Kenyon,
  2. Achilleas Tsoumanis,
  3. Kara Osbak,
  4. Marjan Van Esbroeck,
  5. Tania Crucitti,
  6. Luc Kestens
  1. Institute of Tropical Medicine, Antwerp, Belgium


Introdution There may be a difference in the immune and inflammatory response to repeat as compared to initial syphilis.

Methods Prospective study: We prospectively recruited patients with a new diagnosis of syphilis, described their clinical and demographic characteristics and tested their plasma for IFNa, IFNg, IL-1b, IL-12p40, IL-12p70, IP-10, MCP-1, MIP-1a, MIP-1β, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-17A (Luminex multiplex assay (EMD Millipore) and their serum with a quantitative Rapid Plasma Reagin (RPR) test (Macrovue, Becton, Dickinson) at baseline pre-treatment and 6 months following therapy. The Mann-Whitney U-test was used to assess if cytokine levels and RPR titres differed between those with initial and repeat syphilis sampled at baseline and 6 month time points. Retrospective study: We compared RPR response kinetics between initial and repeat syphilis in persons attending our HIV/STI clinic.

Results Prospective study: 91 individuals, 36 with initial- and 55 with repeat syphilis, were included in the study. At baseline visit those with initial syphilis were more likely to be symptomatic and had higher levels of IL-8, IL-10 and MIP-1β. By the 6 month visit IL-10 remained higher in those with initial syphilis. Median RPR titres were higher at baseline in the repeat compared to the initial infection groups in those with symptomatic (primary and/or secondary) syphilis (1/128 [IQR 1/64-1/256] vs. 1/64 [IQR 1/16-1/128], p=0.016) but not those with latent syphilis. Retrospective study: Syphilis was diagnosed in 1 027/12 520 individuals tested. Repeaters had higher RPR titres at diagnosis and a stepwise increase in RPR titre with number of previous syphilis episodes. They had a different RPR response kinetic: they were less likely to be serofast and less likely to serorevert than initial syphilis. Not one of those with 4 or more episodes of syphilis seroreverted.

Conclusion Repeat syphilis has a different clinical presentation and immunological response than initial infection. We discuss the implications for clinicians and epidemiologists.

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