{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T07:57:47Z","timestamp":1782979067746,"version":"3.54.5"},"reference-count":18,"publisher":"BMJ","issue":"3","funder":[{"name":"National Health and Medical Research Council (NHMRC) Leadership Investigator Grant","award":["GNT1172900"],"award-info":[{"award-number":["GNT1172900"]}]},{"name":"Monash University Research Training Program Stipend","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"Royal Australasian College of Physicians Foundation Research Entry Scholarship","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"Australian NHMRC Emerging Leadership Investigator Grant","award":["GNT1172873"],"award-info":[{"award-number":["GNT1172873"]}]},{"name":"Australian NHMRC Emerging Leadership Investigator Grant","award":["GNT1174555"],"award-info":[{"award-number":["GNT1174555"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Serology is negative in a proportion of primary syphilis cases where <jats:italic>Treponema pallidum<\/jats:italic> PCR testing is positive. We aimed to identify discordant, <jats:italic>T. pallidum<\/jats:italic> PCR-positive, serology-negative primary syphilis cases and any clinical or laboratory factors associated with failure to subsequently seroconvert.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Serodiscordant primary syphilis cases that were <jats:italic>T. pallidum<\/jats:italic> PCR-positive and serology-negative (including rapid plasma reagin, <jats:italic>T. pallidum<\/jats:italic> particle agglutination, <jats:italic>T. pallidum<\/jats:italic> enzyme immunoassay or <jats:italic>T. pallidum<\/jats:italic> chemiluminescence assay) were identified from the Melbourne Sexual Health Centre electronic records between April 2011 and December 2019. Clinical and laboratory associations were examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 814 primary syphilis cases in the study period and 38 (4.7%) were serodiscordant, 35 in men who have sex with men. Thirty-two had follow-up serology performed a median of 24 days later, of which 16 (50%) seroconverted, mostly (81%) within 6\u2009weeks. Failure to seroconvert was significantly associated with treatment on day 1. Of the 12 cases treated on day 1, 10 (83%) failed to seroconvert compared with 6 of 20 (30%) among those who were treated after day 1.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Earlier treatment of primary syphilis can prevent the development of serological markers. <jats:italic>T. pallidum<\/jats:italic> PCR can identify primary syphilis lesions before the development of serological markers and improve diagnosis of early primary syphilis lesions. Serology alone will miss a proportion of primary syphilis infections and should be repeated if a diagnosis of syphilis is being considered.<\/jats:p><\/jats:sec>","DOI":"10.1136\/sextrans-2020-054739","type":"journal-article","created":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T17:29:16Z","timestamp":1617038956000},"page":"161-165","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Timing of primary syphilis treatment and impact on the development of treponemal antibodies: a cross-sectional clinic-based study"],"prefix":"10.1136","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2714-4680","authenticated-orcid":false,"given":"Janet M","family":"Towns","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E","family":"Leslie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Denham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Azzato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theo","family":"Karapanagiotidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7363-6665","authenticated-orcid":false,"given":"Deborah A","family":"Williamson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen R","family":"Graves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9081-1664","authenticated-orcid":false,"given":"Christopher K","family":"Fairley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3686-9184","authenticated-orcid":false,"given":"Melanie","family":"Bissessor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1766-0657","authenticated-orcid":false,"given":"Eric P F","family":"Chow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2343-084X","authenticated-orcid":false,"given":"Lei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus Y","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,3,29]]},"reference":[{"key":"2022100410401122000_98.3.161.1","unstructured":"World Health Organization . 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