Increases in Asymptomatic Early Syphilis May Reflect Increases in Repeated Episodes of Syphilis and Not Enhanced Screening

To the Editor—In their analysis of men who have sex with men (MSM) attending a national sentinel network of 46 sexual health clinics in Australia between 2007 and 2014, Chow et al [1] found a decline in the proportion of syphilis cases that were secondary syphilis and a corresponding increase in early latent syphilis. These changes occurred during a period of increased coverage and frequency of syphilis testing in MSM. The authors interpret this association as representing an "interruption of syphilis progression" and thereby a reduction in the infectiousness of syphilis.