ABSTRACT
Syphilis is on the rise in every age and ethnicity group across the United States. The rate of congenital syphilis has started to rise as well, increasing the need for syphilis screening before pregnancy occurs. Raising awareness for syphilis screening, especially among sexually active women, is important, as the implications of this disease have lifelong effects for mother and child.
Subject(s)
Mass Screening/methods , Pregnancy Complications, Infectious/prevention & control , Syphilis, Congenital/prevention & control , Syphilis/diagnosis , Syphilis/prevention & control , Adolescent , Adult , Antitreponemal Agents/administration & dosage , Female , Humans , Male , Penicillin G/administration & dosage , Penicillin G Benzathine/administration & dosage , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Pregnancy Complications, Infectious/microbiology , Syphilis/drug therapy , Syphilis/microbiology , Syphilis Serodiagnosis/methods , Treponema pallidum/isolation & purification , Treponema pallidum/pathogenicity , Young AdultABSTRACT
BACKGROUND: Treatment guidelines recommend the use of a single dose of benzathine penicillin G (BPG) for treating early syphilis in human immunodeficiency virus (HIV)-infected persons. However, data supporting this recommendation are limited. We examined the efficacy of single-dose BPG in the US Military HIV Natural History Study. METHODS: Subjects were included if they met serologic criteria for syphilis (ie, a positive nontreponemal test [NTr] confirmed by treponemal testing). Response to treatment was assessed at 13 months and was defined by a ≥4-fold decline in NTr titer. Multivariate Cox proportional hazard regression models were utilized to examine factors associated with treatment response. RESULTS: Three hundred fifty subjects (99% male) contributed 478 cases. Three hundred ninety-three cases were treated exclusively with BPG (141 with 1 dose of BPG). Treatment response was the same among those receiving 1 or >1 dose of BPG (92%). In a multivariate analysis, older age (hazard ratio [HR], 0.82 per 10-year increase; 95% confidence interval [CI], .73-.93) was associated with delayed response to treatment. Higher pretreatment titers (reference NTr titer <1:64; HR, 1.94 [95% CI, 1.58-2.39]) and CD4 counts (HR, 1.07 for every 100-cell increase [95% CI, 1.01-1.12]) were associated with a faster response to treatment. Response was not affected by the number of BPG doses received (reference, 1 dose of BPG; HR, 1.11 [95% CI, .89-1.4]). CONCLUSIONS: In this cohort, additional BPG doses did not affect treatment response. Our data support the current recommendations for the use of a single dose of BPG to treat HIV-infected persons with early syphilis.
Subject(s)
Antitreponemal Agents/administration & dosage , HIV Infections/complications , Penicillin G Benzathine/administration & dosage , Syphilis/complications , Syphilis/drug therapy , Adult , Age Factors , Aged , CD4 Lymphocyte Count , Cohort Studies , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Injections, Intramuscular , Male , Middle Aged , Multivariate Analysis , Proportional Hazards Models , Syphilis/diagnosis , Young AdultSubject(s)
Practice Patterns, Physicians' , Syphilis Serodiagnosis/methods , Syphilis/microbiology , Treponema pallidum/isolation & purification , Antitreponemal Agents/administration & dosage , Antitreponemal Agents/therapeutic use , Diagnosis, Differential , False Negative Reactions , False Positive Reactions , Humans , Sensitivity and Specificity , Syphilis/drug therapy , Treponema pallidum/drug effectsABSTRACT
The first choice treatment for late syphilis is penicillin. Other than doxycycline, which penetrates the CNS, there are few alternatives for the treatment of neurosyphilis. We report a case of successful treatment of symptomatic neurosyphilis with parenteral ceftriaxone.
Subject(s)
Antitreponemal Agents/administration & dosage , Ceftriaxone/administration & dosage , Neurosyphilis/drug therapy , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
Neurosyphilis is caused by the spirochete Treponema pallidum. These organisms divide slowly, requiring long exposure to antibacterials for treatment success. In order for an antibacterial to be effective in the therapy of neurosyphilis, it must achieve treponemicidal concentrations in the CSF, have a long half-life and be given in a treatment regimen that favours compliance. Penicillin was first introduced for the treatment of syphilis in 1943, and despite interest in the use of amoxicillin, erythromycin, tetracycline, doxycycline, ceftriaxone and azithromycin, penicillin remains the only recommended antibacterial agent for neurosyphilis.
