Reviewer’s report
Title: 
Management of syphilitic hepatitis
Version: 
0 
Date: 
19 Mar 2020
Reviewer's report:
I agree that further investigation into the rash would have perhaps resulted in
earlier diagnosis. I also agree that syphilis testing should be part of the initial
work-up in patients presenting with hepatitis. However, it is worth mentioning
that, from our experience with HIV patients, about 50% present with mixed
enzyme pattern and in 13% only hepatocellular enzymes are elevated. 
Along with the genital and buccal examination, authors also noted in general no
veneral exposure.
I agree that the treatment described is not standard of care. Perhaps it is worth
mentioning in which situation a more prolonged treatment is recommended. The
statement that SH is a mild disease is not always true (Lo et al. Syphilitic
hepatitis resulting in fulminant hepatic failure requiring liver transplantation. J
Infect. 2007). 
Last paragraph needs minor language corrections.
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
I agree to the open peer review policy of the journal. I understand that my name
will be included on my report to the authors and, if the manuscript is accepted
for publication, my named report including any attachments I upload will be
posted on the website along with the authors' responses. I agree for my report to
be made available under an Open Access Creative Commons CC-BY license
(
http://creativecommons.org/licenses/by/4.0/
). I understand that any comments
which I do not wish to be included in my named report can be included as
confidential comments to the editors, which will not be published.
I agree to the open peer review policy of the journal
Reviewer’s report
Title: 
Management of syphilitic hepatitis
Version: 
0 
Date: 
19 Mar 2020
Reviewer's report:
I agree that further investigation into the rash would have perhaps resulted in
earlier diagnosis. I also agree that syphilis testing should be part of the initial
work-up in patients presenting with hepatitis. However, it is worth mentioning
that, from our experience with HIV patients, about 50% present with mixed
enzyme pattern and in 13% only hepatocellular enzymes are elevated. 
Along with the genital and buccal examination, authors also noted in general no
veneral exposure.
I agree that the treatment described is not standard of care. Perhaps it is worth
mentioning in which situation a more prolonged treatment is recommended. The
statement that SH is a mild disease is not always true (Lo et al. Syphilitic
hepatitis resulting in fulminant hepatic failure requiring liver transplantation. J
Infect. 2007). 
Last paragraph needs minor language corrections.
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
I agree to the open peer review policy of the journal. I understand that my name
will be included on my report to the authors and, if the manuscript is accepted
for publication, my named report including any attachments I upload will be
posted on the website along with the authors' responses. I agree for my report to
be made available under an Open Access Creative Commons CC-BY license
(
http://creativecommons.org/licenses/by/4.0/
). I understand that any comments
which I do not wish to be included in my named report can be included as
confidential comments to the editors, which will not be published.
I agree to the open peer review policy of the journal
Please review this paper.
user
Reviewer’s report
Title: 
Management of syphilitic hepatitis
Version: 
0 
Date: 
19 Mar 2020
Reviewer's report:
I agree that further investigation into the rash would have perhaps resulted in
earlier diagnosis. I also agree that syphilis testing should be part of the initial
work-up in patients presenting with hepatitis. However, it is worth mentioning
that, from our experience with HIV patients, about 50% present with mixed
enzyme pattern and in 13% only hepatocellular enzymes are elevated. 
Along with the genital and buccal examination, authors also noted in general no
veneral exposure.
I agree that the treatment described is not standard of care. Perhaps it is worth
mentioning in which situation a more prolonged treatment is recommended. The
statement that SH is a mild disease is not always true (Lo et al. Syphilitic
hepatitis resulting in fulminant hepatic failure requiring liver transplantation. J
Infect. 2007). 
Last paragraph needs minor language corrections.
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests
I agree to the open peer review policy of the journal. I understand that my name
will be included on my report to the authors and, if the manuscript is accepted
for publication, my named report including any attachments I upload will be
posted on the website along with the authors' responses. I agree for my report to
be made available under an Open Access Creative Commons CC-BY license
(
http://creativecommons.org/licenses/by/4.0/
). I understand that any comments
which I do not wish to be included in my named report can be included as
confidential comments to the editors, which will not be published.
I agree to the open peer review policy of the journal
assistant