Zusammenfassung
Seit 2001 steigt die Inzidenz der Syphilis in Deutschland dramatisch an. Besonders betroffen ist hierbei die Gruppe der homosexuellen Männer. Bei der Behandlung von HIV-Syphilis-Koinfizierten sind einige Besonderheiten bei der Diagnostik und Therapie zu beachten. Da die Labordiagnostik oft unzuverlässig ist, muss der erfahrene Arzt die Klinik besonders berücksichtigen. Der stadienhafte Verlauf der Syphilis unterscheidet sich bei HIV-positiven Patienten im Wesentlichen nicht von HIV-negativen Patienten. Es sind allerdings vermehrt atypische und schwere Verläufe mit rascher Progredienz und ZNS-Beteiligung zu finden. Zudem kommt es häufig zu Fehldiagnosen. Die Therapie erfordert eine besondere Sorgfalt. Penicillin ist das Therapeutikum der Wahl bei allen Stadien der Syphilis bei HIV-Infektion. Allerdings wird die Wahl des Penicillinderivates insbesondere aufgrund der häufig schwierigen Stadienabgrenzung kontrovers diskutiert. Eine sichere Alternative bei Penicillinallergie besteht nicht.
Abstract
The incidence of syphilis has increased dramatically in Germany since 2001. Homosexual men have been particularly afflicted. Several characteristic features should be taken into account in the diagnosis and treatment of HIV patients with concomitant syphilis. Since laboratory analyses are frequently unreliable, the experienced physician must pay special attention to the clinical picture. The stages in the clinical course of syphilis do not differ essentially between HIV-positive and HIV-negative patients. However, atypical and serious courses with rapid progression and CNS involvement are observed more frequently. Moreover, incorrect diagnoses are often reached. Treatment requires particular diligence. Penicillin is the agent of choice for all stages of syphilis in patients infected with HIV. Because the stages are often difficult to differentiate, the choice of which penicillin derivative should be administered is the subject of controversy. There is no safe alternative for patients allergic to penicillin.
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Potthoff, A., Brockmeyer, N.H. Syphilis und HIV-Infektion. Hautarzt 56, 133–140 (2005). https://doi.org/10.1007/s00105-004-0868-3
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DOI: https://doi.org/10.1007/s00105-004-0868-3