Previous Syphilis Alters the Course of Subsequent Episodes of Syphilis

Clin Infect Dis. 2022 Mar 1;74(4):e1-e5. doi: 10.1093/cid/ciab287.


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.

Keywords: Treponema pallidum; neurosyphilis; repeat infection; syphilis.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Humans
  • Neurosyphilis* / cerebrospinal fluid
  • Neurosyphilis* / diagnosis
  • Polymerase Chain Reaction
  • Syphilis* / complications
  • Syphilis* / diagnosis
  • Treponema pallidum / genetics