A Randomized, Comparative Pilot Study of Azithromycin Versus Benzathine Penicillin G for Treatment of Early Syphilis

Hook, Edward W.; Martín, David H.; Stephens, Joan; Smith, Barbara; Smith, Keith

doi:10.1097/00007435-200208000-00010

Cited by 121 publications

(79 citation statements)

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“…Furthermore, they would not lead to the increases in TPPA titres that characterise reinfections. Since all the cases received stage-appropriate, highly effective therapy under direct supervision that has an extremely low failure rate [29], we assume that relapses were very unlikely.…”

Section: (V) Missed Signs Of Diseasementioning

confidence: 99%

“…This can be inferred from comparing the incubation period of syphilis, being a mean of 21 days (range: 10-90 days) [1,12] and the time to positivity of an RPR test (ca 50% and 90% positive by three and six weeks post infection, respectively) [29] with the frequency of RPR testing (median: 114 days; 3%, 7% and 28% of tests were performed at 7, 14 and 90 days post infection, respectively). As only 28% of tests were performed within the maximum 90-day incubation period, this suggests that the lead-time bias is unable to explain more than a minority of the 91% of the repeat cases presenting asymptomatically.…”

Section: (V) Missed Signs Of Diseasementioning

confidence: 99%

“…They suggest that persons with multiple episodes of syphilis may be more likely to present with asymptomatic disease. Because untreated syphilis may remain infectious for more than a year [29], this could result in these individuals having an even larger role in syphilis transmission than their central position in high-risk sexual networks would have led to. This makes a good case for screening these individuals frequently on a long-term basis.…”

Section: (V) Missed Signs Of Diseasementioning

confidence: 99%

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Syphilis reinfections pose problems for syphilis diagnosis in Antwerp, Belgium – 1992 to 2012

et al. 2014

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Persons with multiple syphilis reinfections may play an important role in syphilis transmission. We analysed all syphilis tests carried out for people attending the HIV/sexually transmitted infection (STI) clinic at the Institute of Tropical Medicine, Antwerp, Belgium, from 1992 to 2012 to evaluate the extent to which syphilis reinfections were contributing to the syphilis epidemic in Antwerp. We then characterised the features of the syphilis infections in individuals with five or more episodes of syphilis. A total of 729 syphilis episodes were diagnosed in 454 persons. The majority of syphilis episodes occurred in people who had more than one episode of syphilis (445/729; 61%). A total of 10 individuals had five or more episodes of syphilis diagnosed over this period. All were men who have sex with men, HIV positive and on antiretroviral therapy. They had a total of 52 episodes of syphilis diagnosed and treated. In 38/42 of the episodes of repeat syphilis in these 10 individuals, they presented without any signs or symptoms of syphilis. Given that the majority of cases of incident syphilis in our clinic were persons with reinfections and that they frequently presented without signs of symptoms of syphilis, there is a strong case for frequent and repeated screening in all persons with a diagnosis of syphilis.

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Section: (V) Missed Signs Of Diseasementioning

confidence: 99%

Section: (V) Missed Signs Of Diseasementioning

confidence: 99%

Section: (V) Missed Signs Of Diseasementioning

confidence: 99%

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Syphilis reinfections pose problems for syphilis diagnosis in Antwerp, Belgium – 1992 to 2012

et al. 2014

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“…1 Treatment requires obtaining appropriate levels of penicillin in the CSF to exert an antitreponemicidal effect. 24 Because there have been reports of treatment failures despite appropriate penicillin therapy in primary syphilis, 2,25 it is essential to ensure sufficient declines in titres and normal CSF levels following treatment. Data are limited to guide prognostication.…”

Section: Treatmentmentioning

confidence: 99%

Neurocognitive and psychiatric changes as the initial presentation of neurosyphilis

Costiniuk

MacPherson

2013

CMAJ

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Despite its recognition for centuries as "the great imitator," neurosyphilis re mains a diagnostic challenge because of its wide spectrum of presentations. Here we describe 3 men with neurosyphilis in whom diagnosis and treatment were delayed for up to a year because their initial presentations were in keeping with primary neurological or psychiatric problems. CasesCase 1 A 40-year-old heterosexual man was admitted to a psychiatric ward with a 2-3 week history of excessive talking with senseless conversation, excessive activity, decreased sleep and delusions of grandiosity. The patient had been well previously other than having depression more than 10 years earlier and chronic back pain. Bipolar disorder with manic episode was diagnosed.Investigations included magnetic resonance imaging (MRI), which showed mineral deposits within the globus pallidus ( Figure 1); however, screening for Wilson disease was negative. Further work-up included measurement of iron, ferritin, thyroid-stimulating hormone, vitamin B 12 and folate levels, all of which were within normal limits. Results of toxicology and serologic HIV testing were also negative.Upon admission, the patient received treatment with lithium and olanzapine, as well as temporary sedation with clonazepam. Over the next few months, a mask-like facies developed, his speech became slow and stuttered, and a tremor developed in his right hand. The patient had reduced strength, and his deep tendon reflexes were brisk on the right side. His gate was shuffling, and he had difficulty with turning.The development of neurologic symptoms prompted serologic testing for syphilis. Enzyme immunoassay was positive for antibodies to Treponema pallidum, the T. pallidum particle agglutination assay was reactive, and the rapid plasma reagin test was reactive with a titre of 1:128. Subsequent analysis of the cerebrospinal fluid (CSF) showed a leukocyte count of 42 (normal < 5) × 10 6 /L with 91% lymphocytes, a protein level of 1.43 (normal 0.15-0.45) g/L and a Venereal Disease Research Laboratory (VDRL) titre of 1:4 with a reactive T. pallidum particle agglutination assay. The patient indicated having 2 previous female sexual partners, and there was Cases

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“…The results of two pilot studies suggested that the drug may be effective in preventing syphilis in persons exposed to patients with infectious cases 5 and in treating early syphilis. 6 Expanding on these small pilot studies in the United States, we present the results of a randomized, controlled trial conducted in a developing country to test the hypothesis that the efficacy of a single, 2-g oral dose of azithromycin is equivalent to that of standard treatment with 2.4 MU of penicillin G benzathine for the treatment of early syphilis.…”

mentioning

confidence: 99%

Single-Dose Azithromycin Versus Penicillin G Benzathine for the Treatment of Early Syphilis

2006

Obstetrics & Gynecology

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A Randomized, Comparative Pilot Study of Azithromycin Versus Benzathine Penicillin G for Treatment of Early Syphilis

Abstract: Oral therapy with 2.0 g of azithromycin as a single dose or as two doses 1 week apart is a promising alternative to therapy with benzathine penicillin G for syphilis and should be studied further.

Cited by 121 publications

References 12 publications

Syphilis reinfections pose problems for syphilis diagnosis in Antwerp, Belgium – 1992 to 2012

Syphilis reinfections pose problems for syphilis diagnosis in Antwerp, Belgium – 1992 to 2012

Neurocognitive and psychiatric changes as the initial presentation of neurosyphilis

Single-Dose Azithromycin Versus Penicillin G Benzathine for the Treatment of Early Syphilis

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