Serofast state after syphilis treatment: implications and recommendations for clinical practice. Narrative review

Introduction: Serofast state is defined as an insufficient decrease in the non-treponemal reaction titre after 6-12 months for early syphilis or after 12-24 months for late syphilis counting from the recommended treatment, with the simultaneous resolution of the infection symptoms. Aim: The aim of this article was to review the current understanding of the serofast state. Additionally, data on recommended diagnostic and therapeutic approaches for patients with serofast state were presented. Methods: In order to review the current understanding in the field of serofast syphilis, the PubMed database was searched. Results: The available literature relating to serofast syphilis is mainly concerned with predictive factors of the serofast state. Conclusions: Understanding the predictive factors of the serofast state and its pathomechanism is crucial. This knowledge enables early identification of patients who, following treatment, may require increased clinical supervision and a slightly altered therapeutic management plan.