Abstract
Background
The influence of previous syphilis on the course of a subsequent episode is unknown.
Methods
Individuals enrolled in a study of cerebrospinal fluid (CSF) abnormalities in syphilis were allowed to enroll in the study again with subsequent syphilis. For each participant, the index episode was defined as the most recent syphilis episode for which the study entry visit was performed within 30 days of the syphilis diagnosis date. Venipuncture and lumbar puncture (LP) were performed. Total number of syphilis episodes was determined by review of medical and public health records. T. pallidum DNA in blood and rRNA in CSF were detected by polymerase chain reaction (PCR) and reverse transcriptase PCR. Odds ratios (ORs) with 95% confidence intervals (95% CI) were determined by logistic regression.
Results
651 individuals had one (n = 482), two (n = 121) or three or more (n = 48) episodes of syphilis. The proportion of individuals whose index episode was early latent stage was significantly higher in those with ≥3 syphilis episodes; this relationship was reduced to a trend when rate of testing was taken into account. Adjusted odds (aOR) of detection of T. pallidum DNA in blood or rRNA in CSF at the index episode were significantly lower in those with previous syphilis (0.17 [95% CI, 0.09–0.31] and 0.15 [95% CI, 0.07–0.35]). The aOR for neurosyphilis at the index episode was also significantly lower in individuals with previous syphilis (0.54 [95% CI, 0.34–0.87]).
Conclusions
Previous syphilis attenuates the manifestations of subsequent infection with T. pallidum.
By request of the author, this article has been retracted. An Editor’s Note describing necessary changes may be found at: https://doi.org/10.1093/cid/ciaa1891, and a revised version of the article has been published. The revised article may be found at: https://doi.org/10.1093/cid/ciab287.
Contributor Information
Christina M Marra, University of Washington School of Medicine, Departments of Neurology, Seattle, WA, USA; Medicine (Infectious Diseases), Seattle, WA, USA.
Clare L Maxwell, University of Washington School of Medicine, Departments of Neurology, Seattle, WA, USA.
Sharon K Sahi, University of Washington School of Medicine, Departments of Neurology, Seattle, WA, USA.
Lauren C Tantalo, University of Washington School of Medicine, Departments of Neurology, Seattle, WA, USA.
Shelia B Dunaway, Medicine (Infectious Diseases), Seattle, WA, USA.
Sheila A Lukehart, Medicine (Infectious Diseases), Seattle, WA, USA; Global Health, Seattle, WA, USA.