Audit of the use of benzathine penicillin, post-treatment syphilis serology and partner notification of patients with early infectious syphilis

Abstract

Recent increases in the incidence of early infectious syphilis have been particularly noted in men who have sex with men (MSM). Case-notes of 40 consecutive patients with infectious syphilis and follow-up data for one year were audited. Of the 40 patients, six were HIV co-infected. In all, 31 men received benzathine penicillin as first line while the remaining had other treatments. About 17 (42.5%) failed to attend for any post-treatment serological tests. Of the remainder, 17 (42.5%) attended for the first appointment and only 13 (32.5%) attended for the full one year follow-up. In all, 40 men in the study had 362 sexual contacts of which only 44 (12.2%) elected to be screened. This study illustrates the successful use of benzathine penicillin as first-line treatment, lack of patient compliance with post-treatment serological follow-up and difficulty with partner notification.

Serological response to syphilis treatment in HIV-positive and HIV-negative patients attending sexually transmitted diseases clinics

“…A similar lack of compliance with post-treatment serological follow-up has been reported in the UK. 19 It is possible that some patients did not have follow-up titres documented in the statewide registry because they died, moved out of Maryland or they seroreverted (and thus mandatory reporting by laboratories and doctors of positive serologies does not apply). In HIV-negative patients, RPR seroreversion at 3 and 12 months has been documented to occur in about 13% and 44% of patients with a first episode of primary syphilis, 0.7% and 22% of patients with secondary syphilis and 3% and 13% of patients with early-latent syphilis, 20 respectively.…”

Syphilis and HIV Infection: An Update

“…However, given that previous syphilis, new syphilis, and individual host factors affect nontreponemal titers, the clinical significance of a lack of an appropriate decrease in these titers remains unknown. Lack of follow-up (which is recommended at 1, 3, 6, 12, and 24 months after treatment but only occurs for 20%-40% of patients) further complicates decisions regarding when to re-treat patients who do not respond serologically [60,62]. We recommend observation of the serologic response to treatment of HIVinfected patients for up to 12 months for those with early syphilis and for up to 24 months for those with late syphilis before considering therapy to have failed.…”

The syphilis care cascade: tracking the course of care after screening positive among men and transgender women who have sex with men in Lima, Peru

“… 7–9 However, adherence in our study among MSM and TW in Peru was much worse compared to a small audit study among mostly homosexual/bisexual self-identified men in the UK, where 90% completed their treatment following any antibiotic regimen. 21 Even though that study included adherence to all forms of treatment for syphilis (ie, fewer than three doses of penicillin and regimens that used doxycycline), the higher resources in the UK most likely contributed to more patients completing treatment there versus in either South Africa or Peru.…”