Doesnt really make sense to just directly use Tanzania data as a prior as they have very different absolute effect sizes. But if you take the relative effect from Tanzania as the basis for a beta-binomial prior the net is still similar - there is about a 50% chance that the NNT is 1000 or less.

Here is the Mongolia data quickly re-analysed with a Bayesian model and a beta-binomial prior centred on null. Plotted probability there is a 0.1%, 0.2%, 0.3% absolute risk reduction in TB disease (NNT 1000, 500, 333). <50% chance NNT is 1000 & only a 8.7% chance that is as low as 333.

I attach a copy of the letter I have on several occasions sent to journals when they publish yet another of these trials.

Bridget Freyne presenting CARES-1 trial: The first new trial for congenital syphilis treatment in 30 years & the first ever trial of a non-penicillin treatment for congenital syphilis. Super excited to be part of the team for this trial & looking forward to results over next 12-24 months.

Next up hearing about the creation of an incredible (and I suspect unique) birth cohort of Palestinian refugees pubmed.ncbi.nlm.nih.gov/38414543/ Allows linkage of health & education data in this cohort & to explore (sadly) a wide range of exposures including the impact of conflict on outcomes. 4/n

At @lshtm.bsky.social workshop on administrative data for early life exposures. Wonderful opening Bethania Almedia CIDACS with a paper from 1946 on 'Record Linkage' to generate the Book of Life which still feels highly relevant today. pmc.ncbi.nlm.nih.gov/articles/PMC... 1/n

Wiping clean the last year of grant applications & preparing for this one. As always grateful to a stellar group of colleagues & collaborators who keep the show on the road.

Out @lancetmicrobe.bsky.social & led @amberbarton.bsky.social We used WGS to look at Treponema population dynamics during community MDA for yaws tinyurl.com/bd6zu6xm Intriguingly found sublineage associated w longer ulcer duration & lower antibody titres. Whether occurs in syphilis needs exploring

As ever from Lorenzo, @nicolelieberman.bsky.social & the team at @uwnews.uw.edu a great paper showing variation in Penicillin Binding Proteins in T.pallidum do not appear to impact susceptibility - consistent with what we have observed clinically for 50+ years. journals.lww.com/stdjournal/a...

We found extremely low levels in semen in our cohort study during the 2022 pandemic & (caveat emptor) always below the level at which we could culture it (see also Table S3 in the Supplementary). www.thelancet.com/journals/lan...

Don't worry I think your position is common (especially in USA). Nagoya is a globally agreed set of rules about ensuring protection of rights related to genetic/biological resources. The USA is not a signatory unlike nearly all European, African, Asian and South American governments (see map).

Super proud of my student Philippe Ndzomo awarded PhD today at University of Yaounde. His work focused on the emergence of Hameophilus ducreyi as a cause of cutaneous ulcers in Cameroon & Globally pubmed.ncbi.nlm.nih.gov/40338972/ pubmed.ncbi.nlm.nih.gov/39961439/ pubmed.ncbi.nlm.nih.gov/38150487/

Incredible retirement talk by Prof. Paul Fine @lshtm.bsky.social Career dedicated to global health, critical enquiry & passion for training next generation in UK & esp Malawi where he left huge legacy. Privilege spend 10+yrs at same institution & humbling to know its not even 1/3 time hes been here.

Congratulations to Burrell St Sexual Health: First UK patient into SOS Global - Evaluating mucosal shedding of spirochetes in heterosexual individuals with syphilis. Great collaboration led by Melbourne Sexual Health Centre focused on understanding syphilis transmission.

Great event at the Red Run for World Aids Day - a bracing, wet, windy but highly enjoyable 10km. Still accepting final donations for an excellent cause - @thelovetankcic.bsky.social

Fabulous meeting in Zimbabwe @thruzim.bsky.social for PROMISE Trial Investigating STI screening in 12,000 women in antenatal care thruzim.org/hiv-srh-1/promise Great team across clinical, stats, economics, social science, genomics & basic science to allow us to tackle a wide range of questions

Two syphilis/STI related UK PhD Studentships with our group: Evaluating near-patient syphilis tests with @uclglobalhealth.bsky.social inyurl.com/aw9sapma deadline 5th Dec 2025 Mathematical models to understand partner notification tinyurl.com/2re7xasj deadline 14th Jan 2026 Please do share

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.

Kicking off day 3 Shanghai Syphilis Symposium. There is still a huge amount we can learn from the historic studies to inform our understanding of syphilis immunology and vaccine development.

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.