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Arlene C. Seña, Mark C. Wolff, Edward W. Hook, Reply to Keynan, Clinical Infectious Diseases, Volume 54, Issue 7, 1 April 2012, Pages 1037–1038, https://doi.org/10.1093/cid/cir1021
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TO THE EDITOR—We appreciate Keynan’s comments regarding our manuscript on the predictors of serological cure and serofast state after treatment of early syphilis [1, 2]. His concerns involve 3 issues that require attention: 1) the proportion of participants enrolled in our study; 2) the statistical significance of our reported association between a Jarisch–Herxheimer (J-H) reaction and serological cure at 6 months; and 3) the potential biological plausibility behind this association.
Our randomized treatment trial, originally reported by Hook et al [3], screened 7112 patients from 8 different clinics in North America and Madagascar. Most of these patients (78%) were from Madagascar, and the main reasons for nonenrollment were history of syphilis treatment or antibiotic use, syphilis of unknown duration, or nonreactive rapid plasma reagin tests. Although <10% of the patients screened met the trial’s strict eligibility criteria, we feel that our study population provides a diverse representation of human immunodeficiency virus (HIV)-negative individuals with early syphilis enrolled in a prospective, multicenter, multinational clinical trial.
