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I'm writing to ask if the authors considered an alternate hypothesis:
perhaps the symptoms of primary infection with syphilis are easier to
ignore than chlamydia and gonorrhea--the latter two often cause painful
urination and discharge, while with syphilis (in men) a chancre often
appears in the genital area, usually (but not always) on the penis. These
sores are often painless.
To me it seems quite reasonable...
To me it seems quite reasonable that the painless chancre symptoms of
primary syphilis infection would be a lot easier to ignore than those of
chlamydia and gonorrhea, which manifests in pain and quite obvious
discharge. Those with the latter two would likely seek out treatment and
cease sexual activity (and thereby reduce the spread), while individuals
with syphilis may just ignore the comparatively benign symptom, and
continue to spread it to others. So, infection with different diseases
likely results in different behavioral responses, which in turn affect the
I'm just a layperson so I apologize if this is ridiculous or already
accounted for, but I hope this perspective might help!
Aaron M. Steppe