{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T18:02:59Z","timestamp":1780596179257,"version":"3.54.1"},"reference-count":24,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>A substantial proportion of patients treated for early syphilis fail to achieve the expected \u22654-fold decline in non-treponemal titers despite appropriate therapy. This serofast state remains a common clinical dilemma, and repeated antibiotic therapy is often ineffective. We hypothesized that persistent seroreactivity may reflect infection-associated immune dysregulation rather than ongoing infection. In this prospective study, 36 adults with early syphilis were treated with benzathine penicillin. At 6 months, 11 patients with inadequate serological response underwent cerebrospinal fluid evaluation; 3 with neurosyphilis were excluded. The remaining 33 patients were classified as serofast (n = 8) or serologically cured (n = 25). Eleven healthy individuals served as controls. Serofast patients demonstrated prolonged phospholipid-dependent coagulation assays compared with serologically cured individuals (all qBH &lt; 0.01; \u03b4 = 0.75\u20130.83). They also exhibited higher BAFF levels and B-cell counts at baseline and follow-up. Posttreatment VDRL titers strongly correlated with BAFF levels, B-cell counts, and coagulation parameters. After exclusion of neurosyphilis, persistent non-treponemal seroreactivity was associated with coordinated B-cell activation and phospholipid-dependent coagulation abnormalities, suggesting an infection-triggered immune phenotype rather than ongoing Treponema pallidum infection.<\/jats:p>","DOI":"10.3390\/ijms27114954","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T12:45:08Z","timestamp":1780404308000},"page":"4954","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Serofast Syphilis Is Associated with Phospholipid-Dependent Coagulation Abnormalities and B-Cell Activation Following Treatment"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2539-3221","authenticated-orcid":false,"given":"Martyna","family":"Kiolbasa","sequence":"first","affiliation":[{"name":"Clinical Department of Dermatology, Medical University of Silesia, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7481-2621","authenticated-orcid":false,"given":"Konrad","family":"Kaminiow","sequence":"additional","affiliation":[{"name":"Clinical Department of Dermatology, Medical University of Silesia, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damian","family":"Kadylak","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-214 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Pastuszczak","sequence":"additional","affiliation":[{"name":"Clinical Department of Dermatology, Medical University of Silesia, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1016\/S0140-6736(16)32411-4","article-title":"Syphilis","volume":"389","author":"Hook","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1056\/NEJMra1901593","article-title":"The Modern Epidemic of Syphilis","volume":"382","author":"Ghanem","year":"2020","journal-title":"N. 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