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Evaluation and Management of Syphilis in the HIV-Infected Patient

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Abstract

Rates of syphilis continue to increase in the United States and HIV-infected patients make up a large proportion of cases. The interaction between syphilis and HIV is complex and still incompletely understood. Although diagnosis and management of HIV-infected patients with syphilis is, in general, similar to HIV-uninfected patients, the former may be at increased risk for complications. Recent data suggest that HIV-induced immunosuppression may alter the course of syphilis and that highly active antiretroviral therapy may have a beneficial effect on syphilis outcomes. Prevention strategies consisting of sexual risk assessments, condom use, treatment of infected partners, yearly screening for syphilis of all HIV-infected patients, and enhanced clinical and serologic follow-up of treated HIV-infected patients are critical components of a comprehensive approach to care.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Centers for Disease Control and Prevention: Sexually Transmitted Disease Surveillance, 2007. Atlanta, GA: US Department of Health and Human Services; 2008.

    Google Scholar 

  2. Fleming DT, Wasserheit JN: From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect 1999, 75:3–17.

    Article  CAS  PubMed  Google Scholar 

  3. Buchacz K, Patel P, Taylor M, et al.: Syphilis increases HIV viral load and decreases CD4 cell counts in HIV-infected patients with new syphilis infections. AIDS 2004, 18:2075–2079.

    Article  PubMed  Google Scholar 

  4. • Dowell D, Polgreen PM, Beekmann SE, et al.: Dilemmas in the management of syphilis: a survey of infectious diseases experts. Clin Infect Dis 2009, 49:1526–1529. This study highlights the heterogeneous approach to the management of syphilis among infectious diseases providers around the country.

  5. Sparling PF, Swartz MN, Musher DM, Healy BP: Clinical manifestations of syphilis. In Sexually Transmitted Diseases, edn 4. Edited by Holmes KK, Sparling PF, Stamm WE, et al. New York: McGraw-Hill; 2008:661–684.

    Google Scholar 

  6. Rompalo AM, Joesoef MR, O’Donnell JA, et al.: Clinical manifestations of early syphilis by HIV status and gender: results of the syphilis and HIV study. Sex Transm Dis 2001, 28:158–165.

    Article  CAS  PubMed  Google Scholar 

  7. Flood JM, Weinstock HS, Guroy ME, et al.: Neurosyphilis during the AIDS epidemic, San Francisco, 1985–1992. J Infect Dis 1998, 177:931–940.

    CAS  PubMed  Google Scholar 

  8. Centers for Disease Control and Prevention (CDC): Symptomatic early neurosyphilis among HIV-positive men who have sex with men—four cities, United States, January 2002–June 2004. MMWR Morb Mortal Wkly Rep 2007, 56:625–628.

    Google Scholar 

  9. • Ghanem KG, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA: Neurosyphilis in a clinical cohort of HIV-1-infected patients. AIDS 2008, 22:1145–1151. This study demonstrates that HAART decreased the odds of developing neurosyphilis by 65%.

    Google Scholar 

  10. Musher DM: Syphilis, neurosyphilis, penicillin, and AIDS. J Infect Dis 1991, 163:1201–1206.

    CAS  PubMed  Google Scholar 

  11. Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev 1995, 8:1–21.

    CAS  PubMed  Google Scholar 

  12. •• Centers for Disease Control and Prevention (CDC): Syphilis testing algorithms using treponemal tests for initial screening—four laboratories, New York City, 2005–2006. MMWR Morb Mortal Wkly Rep 2008, 57:872–875. This study highlights an important trend in syphilis diagnostics: the use by some laboratories of treponemal-specific tests as the initial screening test for syphilis and the ensuing issues with the interpretation of tests.

  13. Marra CM, Gary DW, Kuypers J, Jacobson MA: Diagnosis of neurosyphilis in patients infected with human immunodeficiency virus type 1. J Infect Dis 1996, 174:219–221.

    CAS  PubMed  Google Scholar 

  14. Jaffe HW, Larsen SA, Peters M, et al.: Tests for treponemal antibody in CSF. Arch Intern Med 1978, 138:252–255.

    Article  CAS  PubMed  Google Scholar 

  15. Appleman ME, Marshall DW, Brey RL, et al.: Cerebrospinal fluid abnormalities in patients without AIDS who are seropositive for the human immunodeficiency virus. J Infect Dis 1988, 158:193–199.

    CAS  PubMed  Google Scholar 

  16. •• Marra CM, Maxwell CL, Collier AC, et al.: Interpreting cerebrospinal fluid pleocytosis in HIV in the era of potent antiretroviral therapy. BMC Infect Dis 2007, 7:37. This article provides an excellent overview of the issue of CSF abnormalities in HIV-infected patients and describes attempts at trying to improve the specificity of neurosyphilis diagnosis.

  17. Marra CM: Deja vu all over again: when to perform a lumbar puncture in HIV-infected patients with syphilis. Sex Transm Dis 2007, 34:145–146.

    Article  PubMed  Google Scholar 

  18. •• Centers for Disease Control and Prevention, Workowski KA, Berman SM: Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep 2006, 55:1–94. This article provides the definitive management guidelines for syphilis. An updated version should be available in 2010.

  19. Marra CM, Maxwell CL, Smith SL, et al.: Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features. J Infect Dis 2004, 189:369–376.

    Article  PubMed  Google Scholar 

  20. Libois A, De Wit S, Poll B, et al.: HIV and syphilis: when to perform a lumbar puncture. Sex Transm Dis 2007, 34:141–144.

    Article  PubMed  Google Scholar 

  21. • Ghanem KG, Moore RD, Rompalo AM, et al.: Lumbar puncture in HIV-infected patients with syphilis and no neurologic symptoms. Clin Infect Dis 2009, 48:816–821. This study showed that the CD4/RPR-based criteria are superior to the stage-based criteria when attempting to detect asymptomatic neurosyphilis.

  22. Berry CD, Hooton TM, Collier AC, Lukehart SA: Neurologic relapse after benzathine penicillin therapy for secondary syphilis in a patient with HIV infection. N Engl J Med 1987, 316:1587–1589.

    Article  CAS  PubMed  Google Scholar 

  23. Telzak EE, Greenberg MS, Harrison J, et al.: Syphilis treatment response in HIV-infected individuals. AIDS 1991, 5:591–595.

    Article  CAS  PubMed  Google Scholar 

  24. Rolfs RT, Joesoef MR, Hendershot EF, et al.: A randomized trial of enhanced therapy for early syphilis in patients with and without human immunodeficiency virus infection. The Syphilis and HIV Study Group. N Engl J Med 1997, 337:307–314.

    Article  CAS  PubMed  Google Scholar 

  25. Ghanem KG, Erbelding EJ, Cheng WW, Rompalo AM: Doxycycline compared with benzathine penicillin for the treatment of early syphilis. Clin Infect Dis 2006, 42:e45–e49.

    Article  CAS  PubMed  Google Scholar 

  26. Riedner G, Rusizoka M, Todd J, et al.: Single-dose azithromycin versus penicillin G benzathine for the treatment of early syphilis. N Engl J Med 2005, 353:1236–1244.

    Article  CAS  PubMed  Google Scholar 

  27. Lukehart SA, Godornes C, Molini BJ, et al.: Macrolide resistance in Treponema pallidum in the United States and Ireland. N Engl J Med 2004, 351:154–158.

    Article  CAS  PubMed  Google Scholar 

  28. Hook EW 3rd, Roddy RE, Handsfield HH: Ceftriaxone therapy for incubating and early syphilis. J Infect Dis 1988, 158:881–884.

    PubMed  Google Scholar 

  29. Smith NH, Musher DM, Huang DB, et al.: Response of HIV-infected patients with asymptomatic syphilis to intensive intramuscular therapy with ceftriaxone or procaine penicillin. Int J STD AIDS 2004, 15:328–332.

    Article  CAS  PubMed  Google Scholar 

  30. Marra CM, Maxwell CL, Tantalo L, et al.: Normalization of cerebrospinal fluid abnormalities after neurosyphilis therapy: does HIV status matter? Clin Infect Dis 2004, 38:1001–1006.

    Article  PubMed  Google Scholar 

  31. Ghanem KG, Erbelding EJ, Wiener ZS, Rompalo AM: Serological response to syphilis treatment in HIV-positive and HIV-negative patients attending sexually transmitted diseases clinics. Sex Transm Infect 2007, 83:97–101.

    Article  CAS  PubMed  Google Scholar 

  32. Gonzalez-Lopez JJ, Guerrero ML, Lujan R, et al.: Factors determining serologic response to treatment in patients with syphilis. Clin Infect Dis 2009, 49:1505–1511.

    Article  PubMed  Google Scholar 

  33. •• Marra CM, Maxwell CL, Tantalo LC, et al.: Normalization of serum rapid plasma reagin titer predicts normalization of cerebrospinal fluid and clinical abnormalities after treatment of neurosyphilis. Clin Infect Dis 2008, 47:893–899. This recent study suggests that normalization of the serum RPR often predicts normalization of CSF parameters in HIV-infected patients with neurosyphilis who are on HAART.

  34. •• Ghanem KG, Moore RD, Rompalo AM, Erbelding EJ, Zenilman JM, Gebo KA: Antiretroviral therapy is associated with reduced serologic failure rates for syphilis among HIV-infected patients. Clin Infect Dis 2008, 47:258–265. This study demonstrated improved serological outcomes in HIV-infected patients who are treated for syphilis and who are on HAART.

  35. Richardson JL, Milam J, McCutchan A, et al.: Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment. AIDS 2004, 18:1179–1186.

    Article  PubMed  Google Scholar 

  36. Mofenson LM, Brady MT, Danner SP, et al.: Guidelines for the prevention and treatment of opportunistic infections among HIV-exposed and HIV-infected children: recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. MMWR Recomm Rep 2009, 58:1–166.

    PubMed  Google Scholar 

  37. Centers for Disease Control and Prevention (CDC): Recommendations for partner services programs for HIV infection, syphilis, gonorrhea, and chlamydial infection. MMWR Recomm Rep 2008, 57:1,83.

    Google Scholar 

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Authors and Affiliations

  1. Infectious Diseases Division, Johns Hopkins University Bayview Medical Center, 4940 Eastern Avenue, B3N, Suite 352, Baltimore, MD, 21224, USA

    Khalil G. Ghanem

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  1. Khalil G. Ghanem
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Correspondence to Khalil G. Ghanem.

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Ghanem, K.G. Evaluation and Management of Syphilis in the HIV-Infected Patient. Curr Infect Dis Rep 12, 140–146 (2010). https://doi.org/10.1007/s11908-010-0083-6

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  • DOI: https://doi.org/10.1007/s11908-010-0083-6

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