Syphilis management among HIV-infected persons
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]
Overview
Diagnostic Considerations
- Although they are uncommon, unusual serologic responses have been observed among HIV-infected persons who have syphilis. Most reports have involved serologic titers that were higher than expected, but false-negative serologic test results and delayed appearance of seroreactivity also have been reported.[1] Regardless, both treponemal and nontreponemal serologic tests for syphilis can be interpreted in the usual manner for most patients who are coinfected with T. pallidum and HIV.
- When clinical findings are suggestive of syphilis but serologic tests are nonreactive or their interpretation is unclear, alternative tests (e.g., biopsy of a lesion, darkfield examination, and PCR of lesion material) might be useful for diagnosis.
- Neurosyphilis should be considered in the differential diagnosis of neurologic disease in HIV-infected persons.
Treatment
- Compared with HIV-negative patients, HIV-positive patients who have early syphilis might be at increased risk for neurologic complications [3] and might have higher rates of serologic treatment failure with currently recommended regimens. The magnitude of these risks is not defined precisely, but is likely small.
- No treatment regimens for syphilis have been demonstrated to be more effective in preventing neurosyphilis in HIV-infected patients than the syphilis regimens recommended for HIV-negative patients.[2]
- Careful follow-up after therapy is essential.
References
- ↑ Kingston AA, Vujevich J, Shapiro M, Hivnor CM, Jukic DM, Junkins-Hopkins JM et al. (2005) Seronegative secondary syphilis in 2 patients coinfected with human immunodeficiency virus. Arch Dermatol 141 (4):431-3. DOI:10.1001/archderm.141.4.431 PMID: 15837859
- ↑ Rolfs RT, Joesoef MR, Hendershot EF, Rompalo AM, Augenbraun MH, Chiu M et al. (1997) 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 337 (5):307-14. DOI:10.1056/NEJM199707313370504 PMID: 9235493