Syphilis-Naive Patients Achieve Treatment Success More Quickly: A Comparison of Time to Syphilis Treatment Success in Patients With Repeat Versus Naive Infection

We read with great interest the manuscript by Marra et al that described the attenuation of syphilis detection in the blood and cerebrospinal fluid (CSF) in subsequent episodes of syphilis. The authors describe how asymptomatic infection significantly increased with the number of prior syphilis episodes, and that the odds of detecting Treponema pallidum DNA in blood or CSF at the index episode were lower in those with prior syphilis. This information validates prior studies we have conducted, which found differences in cytokine expression among individuals with serofast and treated syphilis. In our studies, we identified 20 pairs of cytokines that differed between active and treated syphilis and identified 3 cytokine networks that could potentially be useful for identifying active syphilis...