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PONE-D-19-31379

Trends of syphilis in Brazil: a growth portrait of the treponemic epidemic

PLOS ONE

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Reviewer #1: The manuscript by Marques dos Santos et al. “Trends of syphilis in Brazil: a growth ” addresses an important situation of the increase in acquired/congenital syphilis infections in Brazil.

Comments:

1. Abstract, Page 2, Lines 30-31: The sentence “In order to analyze the trend and regional distribution of syphilis in Brazil between 2007-2017.” Is an incomplete sentence.

2. Page 3, Line 53: syphilis diagnosis is complex, this should be reworded. Similarly, page 3, Line 70: syphilis has been termed “the great mimicker” which is because the disease is complex in that it mimics many other diseases. It is suggested this be reworded as well, perhaps to emphasize that the disease is easy to treat if appropriately diagnosed.

3. Page 3, Line 71: the wording of this sentence should be revised, suggest “Syphilis is among the…”. The meaning of “contamination by syphilis bacteria” is unclear. Similarly, Page 14, Line 254, the word “contamination” should be removed.

4. Page 4, Lines 81-83: this sentence should be cited by reference 2.

5. Figure 1: the right Y axis should be relabeled for clarity to “rate of acquired syphilis/100,000 inhabitants”.

6. Page 12, Line 221: Table 4 is incorrectly labeled as Table 5.

7. Page 14, Line 268: what do the authors mean by “rightest growth”? This needs to be reworded for clarity.

8. Page 15, Line 289: what is a “reagent non-treponemal test”?

9. Page 16, Lines 295-297: This statement is speculative. The fact that the ratio determination has indicated that syphilis detection in pregnant women is higher than congenital syphilis does not necessarily translate to a higher number of pregnant women being detected in prenatal care. It could also indicate that more infants were born with asymptomatic congenital syphilis.

10. Related to the point above, how has the methodology accounted for asymptomatic congenital syphilis versus no evidence of congenital syphilis (either symptomatic or asymptomatic)? There is significant difficulty in adequately diagnosing congenital syphilis in asymptomatic infants born to seropositive mothers. The authors should note this as a limitation of their study.

11. Page 16, Lines 298-301: this trend could also indicate early diagnosis but lack of treatment. This possibility should be stated.

12. Page 16, Lines 314-315: A broader discussion of the health care services available in the study regions, in relation to the ratio of syphilis in pregnancy/congenital syphilis, would be informative and could uncover additional reasons for the observed trends.

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Reviewer #1: No

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Trends of syphilis in Brazil: a growth portrait of the treponemic epidemic

PONE-D-19-31379R1

Dear Dr. Marques dos Santos,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

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With kind regards,

Zhefeng Meng, M.D., Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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