Syphilis among sexually transmitted infections clinic attendees in a tertiary care institution: A retrospective data analysis

Sir,

I read with interest the article by by Sasidharanpillai et al. ^[1] Some of the deductions made are contentious and need rethinking.

1. Labeling of the patients who have venereal disease research laboratory (VDRL) test titers of 1:4 and/or treponema pallidum hemagglutination (TPHA) 1:80 dilutions as syphilis is not the practice, and needs justification with a reference from Centers for Disease Control and Prevention (CDC) or World Health Organization (WHO)
2. A new terminology of "prenatal" syphilis has been introduced
3. The study is based on retrospective data; so in a VDRL 1:4 positive asymptomatic patient, how can TPHA test be ordered to re-check, or were both the tests performed in every patient attending the sexually transmitted disease (STD) clinic? Over a period of 10 years, only 113 patients were seen in a tertiary care hospital and over the past 10 years, there was a steady decline; but in the later years there was a rise in the number of syphilis cases (how many? No figures are given for the whole period)
4. About half (47.8%) of the patients were diagnosed during a mandatory medical checkup; so this is not clinical data. Besides, more than 90% are stated to belong to the category of syphilis of unknown duration. It is just as likely they were serofast patients because no further work up is mentioned
5. Some cases of primary, secondary, early latent, prenatal, gummatous syphilis and neurosyphilis were seen during the study period. For a tertiary care center, this number is insignificant. A total of eight cases were diagnosed with infectious syphilis during 3 years, amounting to roughly 3 patients per year which is again an insignificant number.

It may be difficult to draw definite conclusions from 8 or 10 patients with infectious syphilis seen over 3 or 10 years when the data is based only on seropositivity. The authors′ warning is mandatory but a rising prevalence has not been documented.