Syphilis among sexually transmitted infections clinic attendees in a tertiary care institution: A retrospective data analysis
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Kumar B. Syphilis among sexually transmitted infections clinic attendees in a tertiary care institution: A retrospective data analysis. Indian J Dermatol Venereol Leprol 2015;81:179
I read with interest the article by by Sasidharanpillai et al.  Some of the deductions made are contentious and need rethinking.
- 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)
- A new terminology of "prenatal" syphilis has been introduced
- 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)
- 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
- 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.