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Editor,—In our area the high HIV prevalence has made the interpretation of syphilis tests paticularly problematic. Coinfected patients do appear to reactivate their treponemal infection or possibly reinfection with a different “strain” in the presence of profound immunosuppression. As with some other agents IgM can persist for several years with peaks and troughs. Non-treponemal tests are uniformly negative while TPHA levels can fluctuate widely. It is perhaps unfortunate that reference laboratories may have developed their algorithms in the face of conventional syphilis diagnosis—these do little to help with HIV coinfected patients.
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