The association of syphilis with risk of human immunodeficiency virus infection in patients attending sexually transmitted disease clinics

Quinn, Thomas C.; Cannon, Robert O.; Glasser, David B.; Groseclose, Samuel L.; Brathwaite, Wayne; Fauci, Anthony S.; Hook, Edward W.

doi:10.1001/archinte.150.6.1297

Cited by 75 publications

(10 citation statements)

References 22 publications

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“…Syphilis has been reported in drug users attending clinics for STDs but it has not systematically been determined in chronic heroin users starting detoxi® cation 19 . Patients from this cross-sectional study were recruited in one of the highest areas of AIDS in Spain and showed multiple risks for HIV and Treponema pallidum infections, including chronic heroin dependence, multiple sexual partners and sex with drug-using partners.…”

Section: Discussionmentioning

confidence: 99%

Syphilis in injecting drug users: clues for high-risk sexual behaviour in female IDUs

et al. 1997

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The objective was to measure the gender-specific differences for syphilis and for the sexual transmission of human immunodeficiency virus (HIV) in a cross-sectional analysis of injecting drug users (IDUs) admitted to detoxification between February 1987 and January 1990. HIV was determined by enzyme-linked immunosorbent assay (ELISA) and confirmed with Western blot. For syphilis reactive samples to a rapid plasma reagent (RPR) were confirmed with treponemal tests (FTA-ABS or MHA-TP). Of the 386 heterosexual IDUs, 68% were HIV-positive and 4.7% had serologic syphilis (RPR and FTA-ABS or MHA-TP positive). Syphilis was higher in women (12%) than in men (3%), and women reported a significantly (P < 0.001) higher number of sex partners. Men had an IDU as a sex partner more often than women did (P = 0.001). Serologic syphilis in women was associated with having had more than one sexual partner in the previous year (P = 0.028) but this association was not present in men. HIV infection was not associated with syphilis in male IDUs. However, HIV was present in all women with syphilis that reported more than one partner.

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Section: Discussionmentioning

confidence: 99%

Syphilis in injecting drug users: clues for high-risk sexual behaviour in female IDUs

et al. 1997

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“…This supports earlier cross-sectional studies, most of which focused on male-to-female HIV transmission. 16,[39][40][41] Apart from being an indicator of unprotected sex, several common STDs are cofactors of HIV transmission, 40,42,43 suggesting that NEPs and drug treatment programs, for example, should place greater emphasis on STD screening and treatment for IDUs. Interventions are needed to reduce sexual risks among women, eg, couple counseling or promoting woman-controlled barriers (including microbicides and female condoms).…”

Section: Commentmentioning

confidence: 99%

Sex Differences in Risk Factors for HIV Seroconversion Among Injection Drug Users

et al. 2001

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The incidence of HIV remained high among IDUs in Baltimore over the past decade. Risk factors for HIV seroconversion differed markedly by sex. Predominant risks among men included needle sharing and homosexual activity; among women, factors consistent with high-risk heterosexual activity were more significant than drug-related risks. Human immunodeficiency virus interventions aimed at IDUs should be sex-specific and incorporate sexual risks.

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“…5,17,38 HIV and syphilis share modes of acquisition and risk factors, including MSM, sexual workers, intravenous drug users, previous history of sexually transmitted diseases (STDs), and multiple partners. Proposed mechanisms for the increased HIV transmission associated with syphilis ulcers 10,34,37 include the tegument disruption; 4,6,11,29 as well as the high concentration of CD4 + cells 23 (which constitute target cells for HIV); and the effect of treponemal lipoproteins, including NTp47, that upregulate HIV replication. 36 Second, experimental data support the importance of cellmediated immune response in syphilis.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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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.

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The association of syphilis with risk of human immunodeficiency virus infection in patients attending sexually transmitted disease clinics

Cited by 75 publications

References 22 publications

Syphilis in injecting drug users: clues for high-risk sexual behaviour in female IDUs

Syphilis in injecting drug users: clues for high-risk sexual behaviour in female IDUs

Sex Differences in Risk Factors for HIV Seroconversion Among Injection Drug Users

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

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