Oral Doxycycline for Treatment of Neurosyphilis in Two Patients Infected with Human Immunodeficiency Virus

Abstract

The frequency of syphilis has been increasing during the past 5 years primarily among men who have sex with men, many of whom are infected with the human immunodeficiency virus (HIV). Data on treatment options other than intravenous or intramuscular penicillin for syphilis are very limited. We describe two HIV-infected patients with asymptomatic neurosyphilis who were successfully treated with oral doxycycline. The first patient was a 45-year-old Hispanic man with well-suppressed HIV RNA who had a positive Venereal Disease Research Laboratory (VDRL) titer of 1:128. His cerebral spinal fluid (CSF) revealed a positive VDRL titer of 1:16, and an elevated white blood cell count of 96 cells/mm(3) and protein level of 89 mg/dl. He received high-dose doxycycline 200 mg twice/day for 28 days. Two months later, his CSF VDRL titer, white blood cell count, and protein level decreased to 1:4, 5 cells/mm(3), and 60 mg/dl, respectively. The second patient was a 37-year-old Caucasian man with complications from acquired immunodeficiency disease. A routine VDRL titer was found to be 1:64. Although the CSF VDRL was nonreactive, both his white blood cell count and protein level were elevated at 29 cells/mm(3) and 46 mg/dl, respectively. High-dose doxycycline 200 mg twice/day was prescribed for 28 days. Three months later, the patient's VDRL titer decreased to 1:2; his CSF white blood cell count decreased significantly to 1 cell/mm(3), and his protein level was within normal limits. Clinicians should be aware that an extended course of high-dose, oral doxycycline may be an effective and safe alternative regimen to intravenous or intramuscular penicillin, without requiring hospitalization or home health care, for the treatment of neurosyphilis in HIV-infected patients. Prospective trials are needed to assess the long-term efficacy oral doxycycline for neurosyphilis.

The Blood–Brain Barrier and Pharmacokinetic/Pharmacodynamic Optimization of Antibiotics for the Treatment of Central Nervous System Infections in Adults

“…They have also been described in case reports to have clinical utility in combination with other agents in the treatment of VRE meningitis [ 187 ]. For CNS infections, doxycycline is the agent with the most clinical experience and the most effective of its class, based on its favorable pharmacokinetics [ 188 , 189 , 190 ]. Its favorable PK data are namely its lipophilicity and high bioavailability after oral administration, ranging between 70 and 95% [ 191 , 192 ], its long elimination half-life of 12–25 h [ 182 ], and its high degree of protein binding [ 52 ].…”

Neurosyphilis Mimicking Behavioral Variant of Frontotemporal Dementia in a 59-Year-Old Man

“…Even though the European guidelines (Janier et al, 2014) do not consider a first- or second-line treatment for a diagnosis of syphilis, we treated our patient with several cycles of doxycycline, which has been shown to successfully treat neurosyphilis due to a good penetration in the CSF (Girometti et al, 2021; Kang-Birken et al, 2010; Yim et al, 1985). We used meropenem to treat the patient during the last hospitalization for the same reason.…”

Cutaneous Rosai – Dorfman disease in a patient with late syphilis and cervical cancer – case report and a review of literature

“…Doxycycline is also a therapeutic option in late syphilis according to the latest '2020 European guideline' [11]. Because of unknown duration of the disease and inability to definitely rule out neurosyphilis a 28day treatment was administered [12,13]. Given the fact that Human Papilloma Virus (HPV) is considered as necessary agent in the development of cervical cancer [14], it can be assumed that HPV infection also co-existed, however molecular testing was not performed.…”