Doxycycline is an alternative antibiotic drug for the treatment of syphilis, but data on its efficacy, especially data on its efficacy against late latent syphilis, are limited. A retrospective study was conducted to evaluate the effectiveness of doxycycline for the treatment of patients with different stages of syphilis. Patients who received doxycycline treatment between June 2011 and June 2014 were involved. The serological response to doxycycline was defined as either a negative toluidine red unheated serum test (TRUST) result or a Ն4-fold decrease in titer at 12 months following the treatment. Univariate and multivariate logistic regression analyses were performed to identify factors associated with the serological response. During the study period, a total of 163 syphilis patients were treated with doxycycline, and 118 patients completed doxycycline treatment and the 12-month follow-up. Among the 118 patients, the serological response rate at 12 months was 100.0% (7/7) in patients with primary syphilis, 96.9% (62/64) in patients with secondary syphilis, 91.3% (21/23) in patients with early latent syphilis, and 79.2% (19/24) in patients with late latent syphilis. The total serological response rates were 92.4% (109/118) for preprotocol (PP) patients and 66.9% (109/163) for all intention-to-treat (ITT) patients. In multivariate analysis, patients who serologically responded at 12 months following treatment were positively associated with a higher baseline TRUST titer and an earlier syphilis stage than nonresponders. Our study showed excellent treatment outcomes in patients with different stages of syphilis. Our data, along with those from other reports, support the usage of doxycycline as a good alternative therapeutic option in the treatment of syphilis.

Poster presentations Background The incidence of syphilis has increased in Hungary (6.3/100000 in 2012), with simultaneous increase in neurosyphilis incidece. The aim of this study is to summarise our experience on clinical and serological characteristics, the treatment results, and association with HIV-infection. Methods clinical, serological and cerebrospinal fluid (CSF) analysis: RPR/VDRL, TPPA/TPHA, TP ELISA, TP IgM/IgG Western blot, albumin, mononuclear cell count of 8 patients with neurosyphilis. The diagnosis of neurosyphlis was based on clinical symptoms, syphilis serology, the positive results of VDRL and/or TPHA tests, and the increased number of mononuclear cells in CSF. Results The 7 male and 1 female patients were between 25 and 84 years of age. 4 male patients were HIV-positive, 3 of them were MSM, one was bisexual. 5 patients had neurosyphilis with symptoms such as headache, dizziness, central facial palsy, visual impairment, sensory loss, diminished tendon reflexes. Asyptomatic patients had schizoaffective disorder, visual impairment, syphilitic reinfection respecively, neurological symptoms were obsereved more frequently in patients with HIV-infection. TPPA/TPHA test in 7 patients', VDRL test in 3 patients' and increased number of mononuclear cells in 7 patients' CSF were positive. All patients were treated with high dose intravenous benzyl penicillin (24 million units iv. daily for 14 days), the effectiveness of treatment was documented by the improvement in clinical symptoms and by the decrease of RPR titer. Conclusion The clinical course was similar in patients with HIV and without it. One third of patients with neurosyphilis was symptoms free, the remaining of them presented clinical symptomps of neurosyphilis. The adequate indication of CSF examination is essential for the diagnosis of neurosyphilis. The long-term penicillin therapy was effective in our cases.