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Robust pro-inflammatory immune response is associated with serological cure in patients with syphilis: an observational study
  1. Maciej Pastuszczak1,
  2. Anna Gozdzialska2,
  3. Bogdan Jakiela3,
  4. Aleksander Obtulowicz1,
  5. Jerzy Jaskiewicz2,
  6. Anna Wojas-Pelc1
  1. 1Department of Dermatology, Jagiellonian University School of Medicine, Cracow, Poland
  2. 2Andrzej Frycz Modrzewski Cracow University, Cracow, Poland
  3. 3Department of Medicine, Jagiellonian University School of Medicine, Cracow, Poland
  1. Correspondence to Dr Maciej Pastuszczak, Department of Dermatology, Jagiellonian University School of Medicine, Skawinska 8 St., Cracow 31-066, Poland; mpastuszczak{at}


Objectives Approximately 15% of adequately treated patients with early syphilis remain serofast. Pathogenesis and clinical significance of this phenomenon is unclear. The objective of this study was to determine whether there is any association between host immune response and treatment outcome (serofast state or proper serological response).

Methods Forty-four patients with secondary syphilis were enrolled to this study. Levels of pro-inflammatory cytokines such as interferon-γ, tumour necrosis factor-α and interleukin-6 were measured before treatment and 8 hours after injection of antibiotic.

Results After 1 year, based on the serological response patients were stratified into two groups: (1) proper serological response (n=31) and (2) serofast state (n=9). The serological cure rate was 77.5% at 12 months after treatment. Patients with proper serological response had significantly higher levels of analysed cytokines (at baseline and 8 hours after treatment) compared with the serofast state group (p<0.05).

Conclusions We showed that robust host pro-inflammatory immune response to infection may be the predictive factor of serological cure. The treatment outcome may be also associated with the magnitude of immune reaction occurring during the treatment.


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  • Handling editor Jackie A Cassell

  • Contributors MP, BJ and AO contributed to the conception and design of the study, wrote and drafted the manuscript and were involved in critical revision of the manuscript. AG and JJ processed and analysed the samples, helped with statistical analysis and reviewed the manuscript. AW-P contributed to the conception of the study and was involved in critical revision of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Jagiellonian University Bioethics Committee (approval number KBET/164/B).

  • Provenance and peer review Not commissioned; externally peer reviewed.