Natural experiment of syphilis treatment with doxycycline or benzathine penicillin in HIV-infected patients

Antonio, Marilia B; Cuba, Gabriel Trova; Vasconcelos, Ricardo; Alves, Ana Paula P S; Silva, Bruna Oliveira da; Avelino‐Silva, Vivian Iida

doi:10.1097/qad.0000000000001975

Cited by 17 publications

(22 citation statements)

References 7 publications

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“…Non‐penicillin antibiotics have been evaluated. These include tetracyclines (doxycycline is the preferred tetracycline with good penetration into the CSF) and macrolides, taken orally 99–103 . Doxycycline has been evaluated more than any other non‐penicillin antibiotics but all studies have been observational and retrospective 100–103 .…”

Section: General Remarks8792–97mentioning

confidence: 99%

“…These include tetracyclines (doxycycline is the preferred tetracycline with good penetration into the CSF) and macrolides, taken orally 99–103 . Doxycycline has been evaluated more than any other non‐penicillin antibiotics but all studies have been observational and retrospective 100–103 . Newer anti‐treponemal antibiotics include the intramuscular or intravenous extended‐spectrum cephalosporin (ESC) ceftriaxone 103–106 .…”

Section: General Remarks8792–97mentioning

confidence: 99%

See 1 more Smart Citation

2020 European guideline on the management of syphilis

Janier

Unemo

Dupin

et al. 2020

Acad Dermatol Venereol

234

313

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The 2020 edition of the European guideline on the management of syphilis is an update of the 2014 edition. Main modifications and updates include: ‐The ongoing epidemics of early syphilis in Europe, particularly in men who have sex with men (MSM) ‐The development of dual treponemal and non‐treponemal point‐of‐care (POC) tests ‐The progress in non‐treponemal test (NTT) automatization ‐The regular episodic shortage of benzathine penicillin G (BPG) in some European countries ‐The exclusion of azithromycin as an alternative treatment at any stage of syphilis ‐The pre‐exposure or immediate post‐exposure prophylaxis with doxycycline in populations at high risk of acquiring syphilis.

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Section: General Remarks8792–97mentioning

confidence: 99%

Section: General Remarks8792–97mentioning

confidence: 99%

2020 European guideline on the management of syphilis

Janier

Unemo

Dupin

et al. 2020

Acad Dermatol Venereol

234

313

View full text Add to dashboard Cite

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“…A high proportion of clinicians who care for patients with HIV continue to use 3 doses of benzathine penicillin G (BPG) to treat early syphilis [9, 14] because of possible concerns regarding the lower efficacy of the recommended 1-dose BPG regimen. Additionally, limited data [15, 16] are available on the efficacy of the alternative regimen, doxycycline, especially for the treatment of late latent syphilis.…”

mentioning

confidence: 99%

Incidence and Predictors of Serological Treatment Response in Early and Late Syphilis Among People Living With HIV

Spagnuolo

Poli

Galli

et al. 2018

Open Forum Infectious Diseases

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BackgroundFew studies have investigated predictors of serological response to syphilis treatment in people living with HIV (PLWH).MethodsThis was a retrospective, longitudinal study on PLWH who were diagnosed with and treated for syphilis who had an assessable serological response between January 2004 and June 2016. Serological treatment response (TR) was defined as a ≥4-fold decline in rapid plasma reagin (RPR) titers or a reversion to nonreactive (if RPR ≤1:4 at diagnosis) 12 months after treatment for early syphilis and 24 months after treatment for late syphilis. Factors associated with a TR were assessed with multivariate Cox proportional hazard models for recurrent events.ResultsA total of 829 episodes of syphilis (686 early, 143 late) in 564 patients were recorded. TR was observed in 732 (88%) syphilis episodes. The proportion of TR differed between early and late syphilis (89% vs 83%, respectively; P = .045). For early syphilis, TR was associated with a higher nadir CD4+ cell count (adjusted hazard ratio [AHR], 1.06; P = .029), an RPR titer >1:32 at diagnosis (AHR, 1.26; P = .009), secondary syphilis (AHR, 1.29; P = .008), and cases of syphilis diagnosed in more recent calendar years (AHR, 1.36; P < .0001). In late syphilis, TR was more likely to occur for first infections (AHR, 1.80; P = .027), for episodes that occurred in more recent years (AHR, 1.62; P = .007), and for RPR titers >1:32 at diagnosis (AHR, 2.04; P = .002). TR was not associated with the type of treatment regimen in early and late syphilis.ConclusionsHigher RPR titers at diagnosis and a diagnosis of syphilis that was made in more recent years were associated with TR in early and late syphilis.

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“…The efficacy of penicillin in the treatment of syphilis showed the following two results: After treatment, the titer of non‐Treponema decreased four times or the serum level reversed. 5 , 6 However, about 5%–41% syphilis patients who are not cured thoroughly after adequate anti‐syphilis treatment by penicillin show consistently low non‐treponemal serum antibody titers (<1:8) post‐treatment and syphilis‐specific antibody positive for a long time or even for a lifetime, 7 which have been regarded to as the serofast state. 8 About 35% of seroresistant syphilis patients with will redevelop into symptomatic syphilis.…”

Section: Introductionmentioning

confidence: 99%

CXCL8, CXCL9, and CXCL10 serum levels increase in syphilitic patients with seroresistance

Dong

Zhang

Yang

et al. 2021

Clinical Laboratory Analysis

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Syphilis infected by Treponema pallidum. As a major global public health problem, as many as 12 million new infections are diagnosed each year worldwide. 1 Parenteral penicillin is crucial to the cure of syphilis at all stages. Because of the difficulty of rapid culture of T. pallidum in vitro and the low sensitivity of PCR detection of patients' serum, 2-4 the evaluation of the efficacy of syphilis treatment depends almost entirely on serological testing. Non-treponemal serum antibody titers detected by tolulized red unheated serum test (TRUST) have been linked to disease activity. The efficacy of penicillin in the treatment of syphilis showed the following two results:

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Natural experiment of syphilis treatment with doxycycline or benzathine penicillin in HIV-infected patients

Cited by 17 publications

References 7 publications

2020 European guideline on the management of syphilis

2020 European guideline on the management of syphilis

Incidence and Predictors of Serological Treatment Response in Early and Late Syphilis Among People Living With HIV

CXCL8, CXCL9, and CXCL10 serum levels increase in syphilitic patients with seroresistance

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