Serologic Response to Treatment of Syphilis in Patients With HIV Infection

doi:10.1001/archinte.1996.00440030127015

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Vol. 156 No. 3, 12 FEBRUARY 1996

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Serologic Response to Treatment of Syphilis in Patients With HIV Infection

Amos M. Yinnon, MD; Patricia Coury-Doniger, RN, FNP; Rita Polito, RN; Richard C. Reichman, MD

Arch Intern Med. 1996;156(3):321-325.

Abstract

Background
Much controversy exists concerning the manifestations, therapy,and response to treatment of syphilis in patients coinfectedwith the human immunodeficiency virus (HIV).

Objective
To assess the effect of HIV infection on the serologic responseto treatment of patients with syphilis.

Methods
Sixty-four HIV-seropositive patients with syphilis were matchedwith 64 patients with syphilis who were HIV negative. Matchingcriteria included age (±5 years), sex, race, initialrapid plasma reagin (RPR) titer (±1 dilution), and stageof syphilis at entry. There were 26 matched patients with earlysyphilis, 26 matched patients with late syphilis, and 12 matchedpatients with biological false-positive RPR. The HIV-positivepatients with early syphilis received three doses of penicillinG benzathine. All other patients received treatment as recommendedby the Centers for Disease Control and Prevention, Atlanta,Ga. Our study's major end points were clinical and serologicresponse to treatment.

Results
All 16 patients with symptomatic syphilis were cured. No patientdeveloped clinical signs of neurosyphilis during the 12-monthfollow-up period. Twenty-nine (56%) of 52 HIV-positive patientswith early or late syphilis did not have a fourfold decreasein RPR titer 6 months after treatment compared with 20 (38%)of 52 matched controls (P=.06). No unique characteristics identifyingpatients who did not respond serologically could be established.The HIV-positive patients with initial RPR less than 1:32 experienceda significantly slower decrease in RPR at 12 months than didthe controls (P<.001).

Conclusions
Patients with syphilis who are HIV positive are less likelyto experience serologic improvement after recommended therapythan are patients with syphilis who are HIV negative. Patientswith HIV infection who contract syphilis should receive intensiveand prolonged follow-up, and consideration should be given todesigning alternative regimens.

(Arch Intern Med. 1996;156:321-325)

Author Affiliations

From the Infectious Diseases Unit, University of Rochester Medical Center, Rochester, NY. Dr Yinnon is now with the Shaare Zedek Medical Center, Jerusalem, Israel.

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