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Original research
Clinical presentation and serological diagnosis of syphilis reinfection in men living with HIV: a retrospective cohort study
  1. Ksenia Mischler-Gornostaeva1,
  2. Martin Glatz1,
  3. Jan Fehr2,3,
  4. Philipp Peter Bosshard1
  1. 1 Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
  2. 2 Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
  3. 3 Department of Public Health, University of Zurich, Zurich, Switzerland
  1. Correspondence to Dr Philipp Peter Bosshard, Department of Dermatology, University Hospital Zurich, Zurich, Switzerland; philipp.bosshard{at}


Objectives Studies on the characteristics of syphilis reinfection are scarce despite increasing numbers and proportions of cases. We aimed to gain insights into the clinical and serological presentation of reinfected men living with HIV and to evaluate diagnostic criteria for syphilis reinfection.

Methods We conducted a retrospective cohort study of 259 HIV-positive men diagnosed with syphilis between January 1999 and September 2015 at the University Hospital Zurich. We compared patients with a single syphilis infection (n=109) to patients with reinfections (n=150).

Results The two groups matched in age, sexual orientation and numbers of other STIs. Reinfected patients more often presented with latent syphilis than patients with a single syphilis episode (41.9% vs 8.9%; p<0.001). Although generally high venereal diseases research laboratory (VDRL) or rapid plasma reagin (RPR) titres (median 1:32) were seen in reinfected patients, 19.4% had titres ≤1:8. Treponema pallidum passive particle agglutination (TPPA) titres were significantly higher (1:81 840 vs 1:10 240; p<0.001), while IgM values were significantly lower (1.27 vs 3.5; p<0.001) in syphilis reinfections than in first infections. The TPPA increased ≥fourfold in >92.3% of reinfected patients.

Conclusions Our data highlight the paramount importance of regularly screening patients at risk as syphilis reinfections in men living with HIV are more likely to be latent infections, that is, without symptoms. As non-treponemal tests might be biologically false-positive (up to a titre of 1:8) due to various conditions, a ≥fourfold increase of the TPPA might be considered as optional criterion for the diagnosis of syphilis reinfections. This could be especially valuable for diagnosing reinfected latent stage patients.

  • syphilis
  • serology
  • diagnostic techniques and procedures
  • diagnosis

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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  • Handling editor Jo Gibbs

  • Contributors JF and PPB contributed to the study concept and design. KM-G and PPB contributed to the acquisition of clinical and laboratory data. PPB has done the statistical analysis. MG and PPB interpreted the data. KM-G, MG and PPB contributed to initial manuscript drafting. MG, JF and PPB were responsible for revisions for intellectual content. All authors approved the final version to be published and agree to be accountable for all aspects of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.