To inform a UK grant application. Similar survey circulated in other countries to guide their applications.

This was funded by @wellcometrust.bsky.social so I just don't understand how this is not open access??

A beautiful example of why when assessing growth of a pathogen in a cell culture line that you need to know if the drug is actually just killing the cell line.

For example T.pallidum doesn't grow in culture when you use ivermectin BUT that's because ivermectin is killing the cell line.

There is exciting progress in identifying human cell lines which could replace rabbit cells in the culture model & could therefore more accurately recapitulate human syphilis infection.

We can use the in-vitro cultivation system to explore the pathogenesis of T.pallidum.

This is helping us understand the interactions between epithelial cells and the pathogen which is critical to transmission and pathogenesis.

Slowly slowly itching towards vaccines...

The schema developed by Sheila Lukehart (queen of syphilis immunology) highlights the key role of cellular immune responses alongside humoral responses in controlling and clearing T.pallidum.

BPG is made up of lots of crystals of penicillin bound to Benzathine. These slowly release penicillin into the blood - so we have a long period of absorption from IM into the blood and then a short elimination half life in the circulation.

The lack of evidence means there is massive variation around the world in how asymptomatic infants with congenital syphilis are managed globally.

We need clearer guidelines informed by well done diagnostic and therapeutic studies.

At one end of the congenital syphilis spectrum are those infants who have symptomatic disease. These children can be severely unwell and we need drugs that can be easily and safely administered to sick neonates.

There remains a depressingly high gap in many LMIC settings between uptake of HIV testing and syphilis testing in Antenatal Care.

And it's not an issue of cost because this is a cheap and hugely cost effective intervention. It's an issue around political will, prioritisation and sustained support.

Introducing a new diagnostic test is not enough to address issues - for syphilis RDTs even though they gave a quicker test turn around it required a full health system intervention for that to be accompanied by an increased uptake of Syphilis treatment

Fundamental health system barriers remain as the major challenge to the implementation of diagnostics. If we don't fix this then no matter how good your new syphilis test is you will still run in to major road blocks in implementing and improving care pathways.

Pregnant women with syphilis are also shedding from their mucosa in a similar fashion to what has been demonstrated in MSM populations.

Neurosyphilis criteria vary from country to country. A classic example of the absence of a reference standard to guide diagnostic pathways & inform management.

We can leverage social network structure to distribute self-testing kits to contacts & there is evidence this is a more effective method than simply asking individuals to refer their contacts for facility based testing.