Enhanced therapy for primary and secondary syphilis: a longitudinal retrospective analysis of cure rates and associated factors

Abstract

For the treatment of early infectious syphilis, enhanced therapy with three dosages of benzathine penicillin G has been under consideration, particularly in the human immunodeficiency virus type 1 infected population (HIV-1). The serological outcome of 249 patients with primary and secondary syphilis treated with standard or enhanced therapy was analyzed retrospectively; 98% (139/142) achieved serological cure with a single dosage and 92% with enhanced therapy (P=0.033). In HIV-1 infected individuals, cure rates were 88% after a single dosage compared to 97% after three dosages (P=0.18). A fourfold decrease of Venereal Disease Research Laboratory (VDRL) titres was achieved within a median of 102 days after treatment initiation (SD=2; 95% CI=98-106). Patients aged over 40 years were 5.5 times (OR=5.52; 95% CI=1.43-21.32; P=0.013) and patients with low baseline VDRL titres (≤ 1:32) were 4 times (OR=4.25; 95% CI=1.21-14.87; P=0.024) more likely to experience serological failure.

Benzathine penicillin G for the management of early syphilis among HIV co-infected persons: A systematic review

“…Overall, four observational studies not included in the 2011 and 2014 systematic reviews included sample sizes of 62 to 350 subjects and concluded that there were no differences in serologic response at 12 (n=2 or 3 studies) or 24 months (n=1 study) if one or three doses BP-G were given (38)(39)(40)(41). The fifth and largest, observational study conducted to date (n=573) in Taiwan hypothesized that one dose was not inferior to three weekly doses of BP-G and set the significant difference between regimens as 10% of participants with a serologic response at 12 months.…”

“…Therefore, the use of anti-retroviral therapy is an important characteristic to include when assessing the efficacy of syphilis therapy. Tittes et al found a slower response to one-dose therapy within an HIV-positive group compared to an HIV-negative group, but there was no significant benefit when the two groups were treated with the three-dose regimen (41 1 Number of study participants analyzed and not necessarily the total number of infections 2 Reflects the number of cases as some study subjects contributed more than one infection SYSTEMATIC REVIEW significant association between higher CD4 count and time to response to therapy (38,40).…”

“…The participants in the studies were predominantly male. In four studies, the intervention was one or three doses of BP-G (37,(39)(40)(41). A single study compared one dose of BP-G with two or more doses of BP-G (38) ( Table 1).…”

“…The lack of adjustment for HIV treatment /status (anti-retroviral therapy and CD4 count) further limits the ability to extrapolate results to the clinical setting. These are known and significant associations (37) but the included publications were not analyzed with a stratified or multivariate approach (37,(39)(40)(41). Studies were not representative of the entire population at risk for syphilis and HIV co-infection.…”

“…The systematic review by Blank et al was focused on HIV coinfected population (19); however, the review by Clement et al, focused more broadly on syphilis with some discussion of HIV co-infection (20). Studies were conducted in Taiwan (37), the United States (38) and Europe (39)(40)(41). The participants in the studies were predominantly male.…”