Early syphilis treatment in HIV‐infected patients: single dose vs. three doses of benzathine penicillin G

Abstract

Background Current treatment guidelines for early stages of syphilis are the same regardless of HIV serostatus. There is still controversy about the best treatment for syphilis in HIV patients and the current recommendations are based on limited data. Objective The primary goal of this study was to compare the serological response rates to a single dose vs. three weekly doses of benzathine penicillin G (BPG) in HIV‐infected patients with early syphilis and to assess the adequacy of current recommendations. Methods Clinical and laboratory data of HIV patients with early syphilis treated in Sexually Transmitted Disease Clinic between January 2000 and December 2014 were recorded. A good serological response was defined as a ≥4‐fold decline in Venereal Disease Research Laboratory (VDRL) titre within 12 months after treatment. Serological failure was defined as a lack of at least fourfold decrease in VDRL titres within 12 months after treatment. Results After applying inclusion and exclusion criteria, 60 patients were enrolled in the study. Seventeen (28.3%) patients were treated with a single dose of BPG, while in 43 (71.7%) patients, three weekly doses were used. Fifty eight (96.7%) had a good serological response at 12 months and seroconversion was confirmed in 29 (48.3%) patients. There was no statistically significant difference between the two treatment groups regarding serological response, seroconversion rate and the time needed to obtain a good serological response. Furthermore, treatment response was not affected by the number of CD4 cells. Conclusions The results of our study support the current international treatment guidelines, recommending early syphilis treatment with a single dose of BPG in HIV patients.

Secondary syphilis mimicking mid-borderline leprosy in HIV-positive patient

“…In neurosyphilis, treatment is recommended with 18-24 million units aqueous crystalline penicillin G per day intravenously, divided in 3-4 million units every 4 hours or continuous infusion for 10-14 days or 2.4 million units aqueous penicillin procaine G intramuscularly with oral probenecid 500 mg every 6 hours for 10-14 days. 14,21, 22 Syphilis patients with HIV who receive adequate therapy should be evaluated clinically and serologically every 3 months during the first year and every 6 months in the second year. The TPHA and RPR test was performed at 3 months after treatment for primary or secondary syphilis to evaluate the success of therapy and detect reinfection.…”

A single dose of benzathine penicillin G as an effective treatment for malignant syphilis in an HIV-positive patient: a case report

“…Major concerns lie in the dierence in clinical features in HIV, impaired host immunity, a higher rate of asymptomatic neurological involvement, and slower serological response (4). There was no notable serological difference in treatment of single-dose versus three-dose BPG in HIV co-infected individuals, suggesting that the international recommendation of a single dose of BPG is sucient in acute infection Benzathine penicillin G for malignant syphilis in HIV (10). Out of 28 reported MS cases that were treated with BPG in 2014-2018, 71.4% received three doses of BPG whereas only 28.6% had a single dose of BPG.…”

The oral presentation of secondary syphilis among men: the evolving interplay between syphilis, HIV and prophylactic strategies

“…66 Yet, the CDC recommends that the same treatment of early syphilis be employed in both HIV-infected and uninfected populations, 34 admittedly, even though some feel that the evidence for this strategy is not optimal nor found in objective data. [67][68] Neither increasing the single dose of BPG, to 3 weekly doses nor the addition of a 10-day course of amoxicillin with probenecid, improves serological outcomes beyond what is achieved with a single dose 35,66,[69][70] regardless of the CD4 count. 35 Although a faster serological response has been reported in patients with higher pretreatment titres < 29 and CD4 counts.…”

“…33,3 Screening for HIV and other STIs should be done at the time of syphilis diagnosis as well as 3 months later, while HIV-infected patients should undergo regular screening for syphilis. 3,5,[34][35] Although syphilis may be transmitted through oral intercourse, [36][37] oral sex is generally considered a low-risk sexual activity for contracting HIV, and therefore usually not protected through barrier use. 38 Yet, HIV can be transmitted through receptive oral intercourse, [39][40] and should therefore be included in safer sex counselling.…”

“…34 Re-infection is particularly likely if clinical signs and symptoms persist or when there is a fourfold increase in non-treponemal test titre. 34 Successful treatment should result in a 4 fold decline in RPR and VDLR titres, [34][35] failure of which will require additional clinical and serological follow-up and screening for HIV infection. 34 Initially, it was believed that the dose and duration of treatment of syphilis should be adjusted among HIVinfected patients.…”