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The diagnosis and management of syphilis in the HIV-infected patient

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Abstract

In the 1980s, the number of cases of syphilis in the United States increased concurrently with the onset of the HIV epidemic. Within a short time, clinicians began to note unusual presentations of syphilis and inappropriate responses to standard therapy for syphilis in dually infected patients. Whether these cases collectively represented a new aspect of the natural history of syphilis remains to be elucidated. In recent years, only a few prospective studies have addressed this issue, and the results of these studies have been inconclusive.

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References and Recommended Reading

  1. Kreiss J, Coombs R, Plummer F, et al.: Isolation of human immunodeficiency virus from genital ulcers in Nairobi prostitutes. J Infect Dis 1989, 160:380–384.

    PubMed  CAS  Google Scholar 

  2. Telzak E, Chiasson M, Bevie P, et al.: HIV-1 seroconversion in patients with and without genital ulcer disease. A prospective study. Ann Intern Med 1993, 119:1181–1185.

    PubMed  CAS  Google Scholar 

  3. Greenblatt R, Lukehart S, Plummer F, et al.: Genital ulceration as a risk factor for human immunodeficiency virus infection. AIDS 1988, 2:47–50.

    Article  PubMed  CAS  Google Scholar 

  4. Plummer F, Wainberg M, Plourde P, et al.: Detection of human immunodeficiency virus type-1 in genital ulcer exudate of HIV-1 infected men by culture and gene amplification [letter]. J Infect Dis 1990, 161:810.

    PubMed  CAS  Google Scholar 

  5. Grosskurth H, Mosha F, Todd J, et al.: Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet 1995, 346:530–536.

    Article  PubMed  CAS  Google Scholar 

  6. Rolfs R, Joesoef R, Hendershot E, et al.: Early syphilis treatment: a randomized trial of enhanced therapy in HIV infected and uninfected persons. N Engl J Med 1997, 337:307–314. s is the only large-scale, prospective trial to study therapy for early-stage syphilis since the beginning of the AIDS epidemic.

    Article  PubMed  CAS  Google Scholar 

  7. Hutchinson C, Hook E, Sheperd M, et al.: Altered clinical presentation of early syphilis in patients with human immunodeficiency virus infection. Ann Intern Med 1994, 121:94–99.

    PubMed  CAS  Google Scholar 

  8. Shulkin D, Tripoli L, Abell E: Lues maligna in a patient with human immunodeficiency virus infection. Am J Med 1988, 85:425–427.

    Article  PubMed  CAS  Google Scholar 

  9. Radolf J, Kaplan R: Unusual manifestations of secondary syphilis and abnormal humoral immune response to Treponema pallidum antigens in a homosexual man with asymptomatic human immunodeficiency virus infection. J Am Acad Dermatol 1988, 18:423–428.

    Article  PubMed  CAS  Google Scholar 

  10. Gourevitch M, Selwyn P, Davenny D, et al.: Effects of HIV infection on the serologic manifestation and response to treatment of syphilis in intravenous drug users. Ann Intern Med 1993, 118:350–355.

    PubMed  CAS  Google Scholar 

  11. Rompalo A, Cannon R, Quinn T, et al.: Association of biologic false positive reactions for syphilis with human immunodeficiency virus infection. J Infect Dis 1992, 165:1124–1126.

    PubMed  CAS  Google Scholar 

  12. Augenbraun M, Dehovitz J, Feldman J, et al.: Biological falsepositive syphilis test results for women infected with human immunodeficiency virus. Clin Infect Dis 1994, 19:1040–1044.

    PubMed  CAS  Google Scholar 

  13. Hicks C, Benson P, Lupton G: Seronegative secondary syphilis in a patient infected with human immunodeficiency virus with Kaposi’s sarcoma. Ann Intern Med 1987, 107:492–495.

    PubMed  CAS  Google Scholar 

  14. Johnson P, Graves S, Stewart L, et al.: Specific syphilis serological tests may become negative in HIV infection. AIDS 1991, 5:419–423.

    PubMed  CAS  Google Scholar 

  15. Augenbraun M, Rolfs R, Johnson R, et al.: Treponemal specific tests for the serodiagnosis of syphilis. Sex Transm Dis 1998, 25:549–552. Treponemal serologic tests (ie, fluoresecent treponemal antibody absorption or microhemagglutination assay-T. pallidum) may frequently become nonreactive after therapy.

    Article  PubMed  CAS  Google Scholar 

  16. Centers for Disease Control and Prevention: 1998 guidelines for the treatment of sexually transmitted diseases. MMWR Morb Mortal Wkly Rep 1998, 47(RR-1):1–116. This is a concise, straightforward, authoritative summation of treatment for sexually transmitted diseases.

    Google Scholar 

  17. Telzak E, Greenberg M, Harrison J, et al.: Syphilis treatment response in HIV-infected individuals. AIDS 1991, 5:591–595.

    Article  PubMed  CAS  Google Scholar 

  18. Moorthy T, Lee C, Lim K, Tan T: Ceftriaxone for the treatment of primary syphilis in men: a preliminary study. Sex Transm Dis 1987, 14:116–118.

    Article  PubMed  CAS  Google Scholar 

  19. Hook E, Roddy R, Handsfield H: Ceftriaxone for incubating and early syphilis. J Infect Dis 1988, 158:881–884.

    PubMed  Google Scholar 

  20. Augenbraun M, Workowski K: Ceftriaxone therapy for syphilis: report from the Emerging Infections Network. Clin Infect Dis 1999, 29:1337–1338.

    Article  PubMed  CAS  Google Scholar 

  21. Verdon M, Handsfield H, Johnson R: Pilot study of azithromycin for the treatment of primary and secondary syphilis. Clin Infect Dis 1994, 19:486–488.

    PubMed  CAS  Google Scholar 

  22. Lukehart S, Fohn M, Baker-Zander S: Efficacy of azithromycin for therapy of active syphilis in the rabbit model. J Antimicrob Chemother 1990, 25(suppl A):91–99.

    PubMed  CAS  Google Scholar 

  23. Hook E, Stephans J, Ennis D: Azithromycin compared with benzathine penicillin for the treatment of incubating syphilis. Ann Intern Med 1999, 131:434–437.

    PubMed  CAS  Google Scholar 

  24. Malone J, Wallace M, Hendrick B, et al.: Syphilis and neurosyphilis in a human immunodeficiency virus type-1 seropositive population: evidence for frequent serologic relapse after therapy. Am J Med 1995, 99:55–63.

    Article  PubMed  CAS  Google Scholar 

  25. Yinnon A, Coury-Doniger P, Polito R, Reichman R: Serologic response to treatment of syphilis with HIV infection. Arch Intern Med 1996, 156:321–325.

    Article  PubMed  CAS  Google Scholar 

  26. Goeman J, Kivuvu M, Nzila N, et al.: Similar serologic response to conventional therapy for syphilis among HIV-positive and HIV-negative women. Genitourin Med 1995, 71:275–279.

    PubMed  CAS  Google Scholar 

  27. Lukehart S, Hook E, Baker-Zander S, et al.: Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment. Ann Intern Med 1988, 109:855–862.

    PubMed  CAS  Google Scholar 

  28. Berry C, Hooten T, Collier A, et al.: Neurologic relapse after benzathine penicillin therapy for secondary syphilis in a patient with HIV infection. N Engl J Med 1987, 316:1587–1589.

    Article  PubMed  CAS  Google Scholar 

  29. Johns D, Tierney M, Felsenstein D: Alteration in the natural history of neurosyphilis by concurrent infection with the human immunodeficiency virus. N Engl J Med 1987, 316:1569–1572.

    Article  PubMed  CAS  Google Scholar 

  30. Swartz M: Neurosyphilis. In Sexually Transmitted Diseases. Edited by Holmes K, Mardh P, Sparling P, Wiesner P. New York: McGraw-Hill; 1990:231–246.

    Google Scholar 

  31. Hollander H: Cerebrospinal fluid normalities and abnormalities in individuals infected with human immunodeficiency virus. J Infect Dis 1988, 158:855–858.

    PubMed  CAS  Google Scholar 

  32. Marra C, Gary D, Kuppers J, Jacobson M: Diagnosis of neurosyphilis in patients infected with human immunodeficiency virus type 1. J Infect Dis 1996, 174:219–221.

    PubMed  CAS  Google Scholar 

  33. Moore J, Hopkins H: Asymptomatic neurosyphilis: VI. Arch Derm Syph 1930, 95:1637–1641.

    Google Scholar 

  34. Augenbraun M, Chiu C: Rates of neurosyphilis in out-patients undergoing lumbar puncture [abstract]. In Proceedings of the 13th Meeting of the International Society for Sexually Transmitted Diseases Research. Denver, 1999:86.

  35. Marra C, Boutin P, McArthur J, et al.: A pilot randomized trial evaluating ceftriaxone and penicillin G as therapies for neurosyphilis in HIV-ACTG 145. Neurology 1999, 52:A193.

    Google Scholar 

  36. Gordon S, Eaton M, George R, et al.: The response of symptomatic neurosyphilis to high-dose intravenous penicillin G in patients with human immunodeficiency virus infection. N Engl J Med 1994, 331:1469–1473.

    Article  PubMed  CAS  Google Scholar 

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  1. SUNY-Health Science Center at Brooklyn, 450 Clarkson Avenue, Box 37, 11203, Brooklyn, NY, USA

    Michael Augenbraun MD

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  1. Michael Augenbraun MD
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Augenbraun, M. The diagnosis and management of syphilis in the HIV-infected patient. Curr Infect Dis Rep 2, 10–13 (2000). https://doi.org/10.1007/s11908-000-0081-1

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  • DOI: https://doi.org/10.1007/s11908-000-0081-1

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