Clinical and Serologic Baseline and Follow-Up Features of Syphilis According to HIV Status in the Post-HAART Era

Abstract

There is a lack of large studies appraising the effect of the human immunodeficiency virus (HIV) on the course of syphilis since the advent of highly active antiretroviral therapy (HAART). We aimed to appraise the effect of HIV on clinical and serologic features of syphilis at baseline and during follow-up in the post-HAART era.We designed a retrospective cohort study of consecutive syphilis cases, diagnosed between 2000 and 2007, in an academic venereal disease center. Data were collected using standardized medical forms. Patients were treated according to the European guidelines. Serologic failure was defined as either a 4-fold rise in Venereal Disease Research Laboratory (VDRL) titers 30-400 days posttreatment or a lack of 4-fold drop in VDRL titers at 270-400 days posttreatment.Among 279 syphilis cases with informative baseline clinical and serologic data, HIV infection was significantly associated with men having sex with men, French origin, multiple partners, lesser usage of condom, history of sexually transmitted disease, early syphilis, anal primary chancre, and cutaneous eruption. Median baseline titer from the Treponema pallidum hemagglutination assay (TPHA) was higher in HIV-infected patients (p = 0.02).Among 144 informative syphilis cases, there was a nonsignificant trend for a lower rate of serologic response among HIV-positive patients (91.8% vs. 98.3%, p = 0.14). Serologic failure was significantly associated with a history of previous syphilis (p < 0.05). The median delay to serologic response was similar in HIV-positive (117 d) and in HIV-negative (123 d) patients (p = 0.44).We conclude that for patients under HAART treatment, the effect of HIV on serologic response to syphilis treatment is likely minimal or absent.

Management of Adult Syphilis: Key Questions to Inform the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines: Table 1.

“…The data from 2 observational cohorts in Africa suggest that HIV-infected and HIV-uninfected persons responded similarly to therapy [21]. A retrospective study by Farhi et al that compared HIV-infected and -uninfected persons with early syphilis found similar responses to therapy in both groups [26]. A meta-analysis by Blank et al confirmed what was suspected: Data quality for treatment studies among HIV-infected persons is poor [24].…”

Host Defense Mechanisms in Secondary Syphilitic Lesions

“…Although studies exist which indicate that the clinical course of syphilis is not significantly distinct between HIV-infected and -uninfected individuals, 36,37 our findings of increased numbers of T. pallidum in lesions of HIV ϩ patients would suggest that the antisyphilitic immune response in these individuals is not very effective, and certainly not protective. It therefore appears that IFN-␥/IL-17-double-positive CD8 ϩ T-cells and macrophages are perhaps needed but do not suffice to eliminate T. pallidum.…”

2014 European guideline on the management of syphilis

“…Osutka przebiega zazwyczaj bez świądu (jest plamista 2-3 miesiące od powstania owrzodzenia, następnie grudkowa), zmiany skórnośluzówkowe występują u 90% pacjentów. Może pojawić się podwyższona ciepłota ciała, uogólniona limfadenopatia, zapalenie wątroby, powiększenie śledziony, zapalenie okostnej, zapalenie stawów i zapalenie kłębusz-ków nerkowych [7][8][9][10][11]. Może dojść do zapalenia opon mózgowordzeniowych, porażenia nerwów czaszkowych, zaburzeń dotyczących narządu słu-chu lub wzroku (zapalenia naczyniówki, siatkówki, zapalenia ucha, poszerzenia źrenic), zmian mózgo-wonaczyniowych (udar, zapalenie rdzenia kręgo-wego).…”