Dose Of Benzathine Penicillin Research Articles

Prevalencia de sífilis en gestantes atendidas en el Hospital Regional de Pedro Juan Caballero, en 2022

Introduction: Syphilis is a common pathology in our population, its early diagnosis is important to avoid complications in pregnant women and newborns since it can trigger serious complications in them. Objective: Determine the prevalence of syphilis in pregnant women treated at the Regional Hospital of Pedro Juan Caballero in the year 2022. Materials and methods: Descriptive, observational, cross-sectional study, where 5940 clinical records of pregnant women were analyzed at the Pedro Juan Caballero Regional Hospital in the period 2022, the study variables were sociodemographic aspects, gynecological-obstetric history and treatment. Results: Of the 5940 records analyzed, we found 74 patients with gestational syphilis, which corresponds to a prevalence of 1.24%, the most frequent age group was between 21 and 30 years in 45%, 80% of pregnant women with syphilis come from In the urban area, the diagnosis of gestational syphilis was made in 45% in children under 12 weeks of gestation and in relation to treatment, 66% of cases received 3 doses of benzathine penicillin.

2889. One vs Three Weekly Doses of Benzathine Penicillin G for Treatment of Early Syphilis in Persons with and without HIV: A Multicenter Randomized Controlled Trial (RCT)

Abstract Background Syphilis rates in the United Stated (U.S.) have increased steadily for over a decade. Despite over 75 years as the drug of choice for syphilis treatment, controversy persists on optimal duration of therapy with benzathine penicillin G (BPG) for persons with early(primary, secondary, and early latent) syphilis, particularly for persons co-infected with HIV. Given the ongoing national shortages of BPG, optimizing duration of therapy is an urgent concern. Methods We conducted a multicenter RCT comparing a single intramuscular (IM) injection of BPG, 2.4 million units to BPG administered for three successive weeks for treatment of early syphilis in persons with and without HIV. The primary outcome of the study was a > 4-fold decline in RPR titer measured at 6 months. Intention to treat (ITT) and per protocol analyses were performed and were similar. ITT analyses are presented here. Results A total of 249 persons with early syphilis were enrolled at 10 participating sites. Most (97%) participants were were categorized as male sex, black race (62%), and 153 (64%) were living with HIV. The syphilis stage distribution was 19% primary, 47% secondary, and 33% early latent and did not differ significantly by HIV status. Serologic response (> 4-fold decline in RPR titer) at 6 months was 76% (95% Confidence Interval (CI) 0.68-0.82) in the single dose group and did not differ significantly from the three-dose group (70%, 95% CI 0.61-0.77). There were no treatment failures (> 4-fold increase in RPR titer). Among persons with and without HIV there was no significant difference in RPR response at 6 months: 76% in the single-dose group vs. 71% in the 3-dose group (95% CI 0.05-0.17). Most participants experienced mild to moderate local injection site pain and tenderness. Conclusion Treatment of persons with early syphilis with more than a single dose of 2.4 million units of BPG offers no therapeutic benefit irrespective of HIV infection status and was associated with increased rates of injection site discomfort. Disclosures Edward W. Hook, III, FIDSA, GARPD (Global Antibiotic Resistance Program: Advisor/Consultant|Talis Biomedical: Advisor/Consultant|VISBY Diagnostics: Advisor/Consultant Candice J. McNeil, MD, MPH, BARDA/GSK: Grant/Research Support|Becton Dickinson: Grant/Research Support|Cepheid: Grant/Research Support|Gilead: Grant/Research Support|Hologic: Grant/Research Support|Lupin: study product Julia C. Dombrowski, MD, MPH, Hologic: Grant/Research Support|Mayne Pharmaceuticals: Grant/Research Support

Secondary Syphilis in a 43-Year-Old Adult Man

We report a case of secondary syphilis simulating Gibert's pityriasis rosé. The patient was a 43-year-old adult with no previous history of syphilis. Erythematous circumscribed plaques were located on the abdomen, back and limbs, with characteristic palmar-plantar involvement. Histological examination was non-specific. Diagnosis was based on the positivity of treponemal tests. The patient's condition improved after administration of two doses of benzathine penicillin.

Case series of stillbirths due to syphilis in Edmonton, Alberta, Canada.

Data were collected on the incidence and characteristics of stillbirths attributed to congenital syphilis (CS). Data were extracted on stillbirths in Edmonton Zone January 1, 2015, through June 30, 2021, born to persons diagnosed with infectious syphilis (primary, secondary, early latent, or early neurosyphilis) during pregnancy or at the time of delivery. Of 314 infants documented to be exposed to infectious syphilis during gestation, 16 (5.1%) were stillborn. Three of the 16 females with stillbirths diagnosed with syphilis during pregnancy but not treated, 12 were diagnosed only at the time of stillbirth (one of whom was treated early in pregnancy and presumably reinfected), and one had a stillbirth in the week following one dose of benzathine penicillin G. Stillbirths due to CS were all due to failure to treat syphilis in pregnancy. Innovative strategies to prevent syphilis in the community and to reach those experiencing barriers to care are urgently required to not miss opportunities to diagnose and treat syphilis as early as possible during pregnancy.

Secondary Syphilis and Human Immunodeficiency Virus (HIV) Co-infection in Men Who Have Sex with Men (MSM) with Triple Doses Benzathine Penicillin G Treatment: A Case Report

Background: World Health Organization (WHO) reported that there are 6 million new cases of syphilis worldwide per year. The incidence of syphilis in Indonesia has increased over the past few years, particularly among men who have sex with men (MSM). Purpose: To report a case of secondary syphilis with Human Immunodeficiency Virus (HIV) coinfection in MSM, thereby increasing understanding of high-risk sexual behavior among MSM. Case: A 26-year-old man with a chief complaint of rashes on both palms, soles of the feet, and face. The rashes spread with no itching, heat, or pain, which occurred two weeks ago. The patient was diagnosed with HIV in 2019. Physical examination found multiple violaceus macules with clear boundaries, 0.5–1 cm in size, covered with scales. Venereal Disease Research Laboratory (VDRL) serology titer was 1:16 and Treponema Pallidum Haemagglutination Assay (TPHA) was 1:20.480. The recent CD4 count was 440 with an undetectable HIV RNA viral load. Benzathine penicillin G 2.4 million units was given intramuscularly 3 times at 1-week intervals. The patient experienced clinical improvement and decreased VDRL and TPHA titers. Discussion: Syphilis patients with or without HIV would have similar clinical symptoms. However, syphilis patients with HIV tend to have more extensive lesions. The treatment option with three doses of benzathine penicillin G is still very effective in cases of syphilis with HIV. Conclusion: Syphilis has a higher incidence in MSM patients with extensive clinical manifestations of skin lesions. It can be observed in syphilis patients with HIV; therefore, close monitoring is needed.

LB1576. High Prevalence of Oral Treponema pallidum by PCR among US Adults with Early Syphilis

Abstract Background Treponema pallidum (T. pallidum) is transmitted from person to person by direct contact with widespread dissemination early after acquisition. Current syphilis diagnostic testing is limited to darkfield microscopy from visible lesions and serologic antibody detection. T. pallidum molecular diagnostics are urgently needed. Methods As part of a multicenter US syphilis treatment trial that completed enrollment in March 2022 (NCT 3637660), we randomized 249 adults with early syphilis infection to 1 vs 3 weekly doses of benzathine penicillin G to compare treatment response at 6 months. In a small substudy (n=32) presented here, consenting participants at the University of Alabama at Birmingham (UAB) and Emory University had pre-treatment oral (buccal mucosa and posterior pharynx) and lesion swab samples collected. Following DNA extraction, T. pallidum burden in samples was quantified by targeting the tp0574 gene. Syphilis was staged by experienced providers according to physical examination and serology. Results Study participants were men (100%) and most were living with HIV (91%) with mean CD4 count 477 cells/mm3. Syphilis stage was categorized as primary in 6 (19%), secondary in 18 (56%) and early latent in 8 (25%). Oral swab qPCR positivity rates were 17% in primary disease, 44% in secondary disease, and 63% in early latent disease (see Figure). Lesion PCR positivity was similar in primary and secondary syphilis (40% and 38.5%). Mean treponemal burden was highest on oral swabs of participants with early latent syphilis (13,128,969) and lesion swabs of participants with secondary syphilis (2,033,309). Conclusion Among adult males, many living with HIV, data suggest a role for oral and lesion swabs for the molecular detection of T. pallidum. Widespread availability of PCR, the relative ease of oral specimen collection, and the opportunity to directly demonstrate T. pallidum in persons with early latent syphilis suggest the opportunity for PCR testing to enhance and refine syphilis diagnostic testing. The elevated proportion of positive oral samples and significant organism burden in secondary and early latent syphilis is consistent with potential for transmission. Disclosures All Authors: No reported disclosures.

A Review on the Diagnosis and Treatment of Syphilis

Syphilis is a multi-phase sexually transmitted disease through contacting with a partner infected by syphilis or from a gravida to her newborn congenitally. The reappearance of syphilis is a severe public health concern, particularly because syphilis lesions would boost the chance of acquiring and spreading human immunodeficiency virus (HIV) infection. A dose of benzathine penicillin G (BPG) through intramuscular injection is the current treatment for syphilis, which is the optimal treatment for all stages of syphilis. Although some alternatives such as doxycycline and ceftriaxone are also evidently effective, the optimal therapy is still BPG, especially in latent syphilis and pregnancy. Because of the clinically significant azithromycin resistance, this second-line medication is no longer used routinely. Currently, macrolide resistance is the only antibiotic resistance with clinical evidence. Even though still no vaccine is published for syphilis, syphilis is a promising disease for vaccine development. The vaccine for syphilis is currently under research. This paper contained information about the pathological process, symptoms, diagnosis of syphilis, and effective treatment using antibiotics. The review also discussed future vaccine directions.

MO202: Pulmonary-Renal Syndrome in Patient with Chronic Hepatitis C And HIV Disease

Abstract BACKGROUND AND AIMS Pulmonary-renal syndrome (PRS) is characterized by rapidly progressive glomerulonephritis and lung vasculitis. Most common causes of PRS are Goodpasture's disease, antineutrophil cytoplasm antibody (ANCA) associated vasculitis and systemic lupus erythematosus; rarely it could be caused by cryoglobulinemic vasculitis. ANCA and cryoglobulins are present in a wide range of infectious, inflammatory and malignant conditions with or without evidence of clinical vasculitis. ANCA positivity has been described in patients with human immunodeficiency virus (HIV) or chronic hepatitis C (HCV), but only a negligible proportion of these patients developed true ANCA vasculitis. Cryoglobulinemia is seen in ∼50% of patients with HCV and ∼5% of these patients have symptomatic disease. According to previous studies, rapidly progressive glomerulonephritis and pulmonary involvement are rare manifestations of cryoglobulinemia. We describe a patient with HIV and HCV infection who presented with rapidly progressive glomerulonephritis and lung vasculitis. METHOD Case report presentation. RESULTS A 43-year-old male presented with fatigue, nausea and decreased urinary output of 3–4 days. Vital signs were stable and physical examination showed abdominal distention and peripheral oedema. His past medical history included heroin abuse. However, he denied any illicit drug use, and he had been on methadone maintenance treatment for 8 years. The patient was diagnosed with HIV 11 years previously. His antiretroviral therapy included abacavir, dolutegravir and lamivudine. CD4 count before admission was 180–200 cells/mm3. In addition to HIV infection, the patient had HCV diagnosed 20 years ago, but he has not received any treatment. The laboratory tests revealed pancytopenia (leukocytes 1.3 × 109/L, haemoglobin 66 g/L, platelets 66 × 109/L), kidney injury (proteinuria 0.8 g/24 h and haematuria) with renal insufficiency (creatinine 727 mcmol/L, urea 36.6 mmol/L). Ultrasound workup demonstrated diffuse changes in liver parenchyma with signs of portal hypertension, and normal-sized, non-obstructed kidneys with Grade 0 parenchymal echogenicity. Chest CT revealed wide areas of ground-glass opacity with patchy airspace consolidations, more severe in the left upper lobe. A serologic workup was positive for cryoglobulins, ANA, c-ANCA (high titre of anti-PR3 143 IU/mL), with decreased levels of C3 and C4. CRP level was slightly elevated (40 mg/L). Moreover patient had positive treponemal and non-treponemal syphilis serological tests. An ultrasound-guided renal biopsy showed crescentic glomerulonephritis with predominant IgM and focal C3, C1q deposition in glomerular capillary walls without any significant glomerular proliferative features. Changes could be interpreted as an immune complex and/or cryoglobulin-mediated glomerulonephritis, but overlapping pauci-immune glomerulonephritis could not be ruled out. Haemodialysis was initiated due to kidney failure and hyperhydration. The patient was treated with pulse methylprednisolone followed by a tapering course of oral prednisolone. Rituximab 1000 mg was prescribed after excluding HIV opportunistic infections, and treatment of syphilis with three doses of benzathine penicillin was used. Due to low GFR, HIV treatment was switched to Dolutegravir/Rilpivirine. The patient refused to initiate HCV therapy. The patient responded well to treatment and lung vasculitis and kidney function improved, therefore haemodialysis was discontinued. Serum creatinine level decreased to 130–120 mcmol/L and remained stable after 18 weeks since the treatment. CONCLUSION PRS in a patient with chronic infections, positive cryoglobulins and positive c-ANCA clinically seems more applicable to c-ANCA vasculitis than to cryoglobulinemic vasculitis. Still overlapping of both diseases could not be excluded.

Management of Adult Syphilis: Key Questions to Inform the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines.

A panel of experts generated 5 "key questions" in the management of adult syphilis. A systematic literature review was conducted and tables of evidence were constructed to answer these questions. Available data suggest no clinical benefit to >1 dose of benzathine penicillin G for early syphilis in human immunodeficiency virus (HIV)-infected patients. While penicillin remains the drug of choice to treat syphilis, doxycycline to treat early and late latent syphilis is an acceptable alternate option if penicillin cannot be used. There are very limited data regarding the impact of additional antibiotic doses on serologic responses in serofast patients and no data on the impact of additional antibiotic courses on long-term clinical outcomes. In patients with isolated ocular or otic signs and symptoms, reactive syphilis serologic results, and confirmed ocular/otic abnormalities at examination, a diagnostic cerebrospinal fluid (CSF) examination is not necessary, because up to 40% and 90% of patients, respectively, would have no CSF abnormalities. Based on the results of 2 studies, repeated CSF examinations are not necessary for HIV-uninfected patients or HIV-infected patients on antiretroviral therapy who exhibit appropriate serologic and clinical responses after treatment for neurosyphilis. Finally, several important gaps were identified and should be a priority for future research.

Outcomes of infectious syphilis in pregnant patients and maternal factors associated with congenital syphilis diagnosis, Alberta, 2017–2020

Background: Congenital syphilis (CS) is a significant public health challenge, requiring early diagnosis and treatment to improve infant outcomes. The aim of this study is to describe public health outcomes of infectious syphilis cases among pregnant patients and factors associated with a CS diagnosis for their infant. Methods: We conducted a retrospective review of demographic and clinical characteristics of infectious syphilis cases diagnosed during pregnancy and resulting infant outcomes in Alberta from 2017 to 2020 from the provincial communicable disease database. Adequate maternal treatment was defined as receiving at least one dose of Benzathine penicillin G-LA 2.4 million units IM at least 28 days before delivery. Univariate and multivariate analysis was performed to determine factors associated with CS diagnosis using SPSS version 25. Results: A total of 374 cases of infectious syphilis were diagnosed in pregnancy, with two patients being diagnosed twice in a single pregnancy. The majority (79.1%; n=296) of women had a live birth, followed by therapeutic abortion (9.4%; n=35), stillbirth (7.5%; n=28) and spontaneous abortion (4.0%; n=15). Infant records (n=265) were available for review (n=117 CS cases and 148 non-cases). Correlates associated with CS were screening time in third trimester (adjusted odds ratio [AOR] 8.4, 95% confidence interval [CI], 2.9–24.6) and fewer than 28 days before delivery (AOR 8.1, 1.4–47.8 [vs. first and second trimester] and inadequate treatment (AOR 86.1, CI, 15.9–466.5). Among the CS cases, 23.1% (n=27) were stillborn compared with one (0.7%) stillbirth in the non-CS infants (p<0.001). Conclusion: The early identification and treatment of syphilis in pregnancy is crucial to preventing poor infant outcomes.

High Baseline C-Reactive Protein Level Can Predict the Occurrence of the Jarisch-Herxheimer Reaction in Patients with Active Syphilis.

BackgroundThe Jarisch–Herxheimer reaction (JHR) is an inflammatory reaction that can occur after treatment for syphilis. The mechanism of JHR is unknown. The level of C-reactive protein (CRP) increases during infection and inflammation. We hypothesized that CRP may be involved in the JHR in syphilitic patients at initial syphilis infection and also through interactions with benzathine penicillin-induced phagocytosis.MethodsThis prospective cohort study enrolled syphilitic adult patients with/without JHR between July 2018 and October 2020. Serum samples before and after the administration of the first dose of benzathine penicillin were obtained. The serum level of CRP was determined by ELISA. The Kruskal–Wallis test was used to compare the levels of CRP in different groups, and the Wilcoxon signed-rank test was used to compare changes in CRP before and after benzathine penicillin treatment.ResultsTwenty-nine syphilitic patients and three control groups (10 men who have sex with men (MSM) taking pre-exposure prophylaxis, 10 HIV-infected patients without syphilis, and 12 HIV-infected patients with previous syphilis) were enrolled. All 29 syphilitic patients were MSM, and 21 patients (72%) were infected with HIV. Overall, 41% (12/29) of the patients developed the JHR. The active syphilis groups had significantly higher serum levels of CRP (median 11,761 ng/mL, IQR 2986–19,061 ng/mL). There were no significant differences in the serum levels of CRP before or after benzathine penicillin treatment. The 12 patients with the JHR had significantly higher CRP levels before benzathine penicillin treatment (16,262 ng/mL [IQR 12,033–26,150 ng/mL] vs 3489 ng/mL [IQR 924–160,640] ng/mL, p = 0.0059, 95% CI 4002–17,098 ng/mL, area under the curve 0.799, 95% CI 0.632–0.966, sensitivity 1, specificity 0.647, with a CRP cut-off value of 4569.32 ng/mL).ConclusionA high baseline CRP level can predict the occurrence of the JHR in syphilitic patients treated with benzathine penicillin.

Psoriasiform Secondary Syphilis: A Pitfall in Diagnosis

Secondary syphilis in Acquired Immune Deficiency Syndrome (AIDS) patient’s have variety of skin manifestations. Failure to recognize the manifestations of secondary syphilis can cause delaying the therapy. The recognition of the characteristics of skin lesions as well as serology examination and histopathology help the physicians for making the diagnosis. A 24-year-old male who was diagnosed with HIV previously came with chief complaint of scaly red plaques on the palms and soles. The similar lesions were also notedover the face especially the perioral region.Patient also noted to have also alopecia on the eyebrows and eyelashes. Patient was diagnosed with psoriasis vulgaris from previous physician and treated with unknown therapy. Serological examination revealed reactive TPHA and high titer of VDRL. Skin biopsy was done and it has features of psoriasis but without pathognomonic signs. The patient then was treated with single dose of benzathine penicillin G 2,4 million units which provided excellent improvement.Secondary syphilis is called "great imitator" because of its broad manifestations. It has been widely reported that secondary syphilis has been misdiagnosed as psoriasis and seborrheic dermatitis. Characteristics of the lesion, serological examination and histopathology play significant role in establishing the diagnosis.

Lues Maligna in an Immune-Reconstituted Patient with Retroviral Infection: A Case Report

Lues Maligna in an Immune-Reconstituted Patient with Retroviral Infection: A Case Report

A Rare Type of Balanitis


 
 
 
 Syphilis is an old disease and a major public health concern, which is re-emerging in the western world. Atypical syphi- litic presentations can be challenging to diagnose. We present a 23-year-old, HIV-positive man who has sex with men who presented with a 2-week history of an asymptomatic lesion on the glans. Previous topical and systemic treatments proved unsuccessful. Physical examination demonstrated a slightly indurated, ill-defined erythematous plaque over most of the glans. Enlarged, non-tender, bilateral inguinal lymph nodes were palpable. Serological tests revealed a fourfold increase in the VDRL titre (1:8, previously 1:2). A diagnosis of syphilitic balanitis of Follmann was made and complete resolution was achieved with an intramuscular single dose of benzathine penicillin 2.4 MU.
 Syphilitic balanitis of Follmann represents an uncommon manifestation of primary syphilis, with less than 100 cases reported. Untrea- ted, it will resolve spontaneously, but the patient will remain highly infectious and at-risk for long-term morbidity. In an era in which the number of syphilis cases is increasing sharply both in Western Europe and the United States, all physicians should be aware for the typical and atypical early syphilitic manifestations as they represent opportunities of paramount importance for treatment and epide- mic control.
 
 
 

Case report of secondary syphilis in a fifteen year old boy

Syphilis is a sexual transmitted infection caused by a spirochete, Treponema pallidum. We report a case of a fifteen-year-old boy with secondary syphilis. A boy from a poor socioeconomic background presented with a non-healing growth on his penis of about one-month duration. On examination, a condylomata lata was found on the inner aspect of the prepuce, which is a clinical feature of secondary syphilis. He had generalized lymphadenopathy, but had no other clinical features of secondary syphilis. His Venereal Disease Research Laboratory (VDRL) test titre was reactive at 1:128. The Treponema Pallidum Particle Agglutination (TPPA) test was strongly positive, confirming the diagnosis of a treponemal infection. The recommended treatment of a single dose of benzathine penicillin, 2.4 million units was administered intramuscularly. He did not develop a Jarisch–Herxheimer reaction. The lesion on his penis healed within a week of treatment. Follow up VDRL titres were 1:8, 1:4, 1:2 and non-reactive at three months, six months, one year and two years, respectively. Though this was clearly a case of child sexual abuse, the legal system could not be activated because the child categorically denied being abused or having any form of sexual contact.

Rheumatic heart disease in Timor-Leste school students: an echocardiography-based prevalence study.

To determine the prevalence of rheumatic heart disease (RHD) in school-aged children and young people in Timor-Leste. Prospective cross-sectional survey. Echocardiography was performed by Australian cardiologists to determine the presence of RHD. Demographic data were also collected. Patients in whom RHD was detected were entered into a register to allow monitoring of adherence to secondary prophylaxis; the first dose of benzathine penicillin G (BPG) was administered on the day of screening. Schools in urban (Dili) and rural (Ermera) Timor-Leste. School students aged 5-20 years. Definite and borderline RHD, as defined by World Heart Federation echocardiographic criteria. 1365 participants were screened; their median age was 11 years (IQR, 9-14 years), and 53% were girls. The estimated prevalence of definite RHD was 18.3 cases per 1000 population (95% CI, 12.3-27.0 per 1000), and of definite or borderline RHD 35.2 per 1000 (95% CI, 26.5-46.4 per 1000). Definite (adjusted odds ratio [aOR], 3.5; 95% CI, 1.3-9.4) and definite or borderline RHD (aOR, 2.7; 95% CI, 1.4-5.2) were more prevalent among girls than boys. Eleven children (0.8%) had congenital heart disease. Of the 25 children in whom definite RHD was identified, 21 (84%) received education and a first dose of BPG on the day of screening; all 25 have since received education about primary care for RHD and have commenced penicillin prophylaxis. The rates of RHD in Timor-Leste are among the highest in the world, and prevalence is higher among girls than boys. Community engagement is essential for ensuring follow-up and the effective delivery of secondary prophylaxis.

Early syphilis treatment in HIV-infected patients: single dose vs. three doses of benzathine penicillin G.

Current treatment guidelines for early stages of syphilis are the same regardless of HIV serostatus. There is still controversy about the best treatment for syphilis in HIV patients and the current recommendations are based on limited data. The primary goal of this study was to compare the serological response rates to a single dose vs. three weekly doses of benzathine penicillin G (BPG) in HIV-infected patients with early syphilis and to assess the adequacy of current recommendations. Clinical and laboratory data of HIV patients with early syphilis treated in Sexually Transmitted Disease Clinic between January 2000 and December 2014 were recorded. A good serological response was defined as a ≥4-fold decline in Venereal Disease Research Laboratory (VDRL) titre within 12 months after treatment. Serological failure was defined as a lack of at least fourfold decrease in VDRL titres within 12 months after treatment. After applying inclusion and exclusion criteria, 60 patients were enrolled in the study. Seventeen (28.3%) patients were treated with a single dose of BPG, while in 43 (71.7%) patients, three weekly doses were used. Fifty eight (96.7%) had a good serological response at 12 months and seroconversion was confirmed in 29 (48.3%) patients. There was no statistically significant difference between the two treatment groups regarding serological response, seroconversion rate and the time needed to obtain a good serological response. Furthermore, treatment response was not affected by the number of CD4 cells. The results of our study support the current international treatment guidelines, recommending early syphilis treatment with a single dose of BPG in HIV patients.

P206 ‘Doctor, I think I’m allergic to penicillin’ - primary syphilis in the third trimester

Case Report We present a case of primary syphilis in the third trimester of pregnancy requiring penicillin desensitisation. A 34-year old woman was contacted by provider referral as a syphilis contact. She was 30 weeks pregnant. Both HIV and syphilis serology were negative at booking. She had presented to a community clinic with a sore vulva one week before and had empirical aciclovir for possible genital herpes. In our clinic, examination showed a small, non-indurated ulcer. Dark-ground microscopy was not done. A syphilis antibody screen was requested and reported positive six days later. On recall, repeat examination showed a larger, indurated ulcer. Treatment for primary syphilis was advised before confirmatory testing. However, the patient reported a possible reaction to penicillin. This was also documented by her general practitioner but the reaction was unknown. The next day she was admitted for penicillin desensitisation and the first dose of benzathine penicillin. Urgent referral to foetal medicine was made. Treponema pallidum was later detected by PCR on a vulval swab. Syphilis serology was reported as RPR 1:8 and TPPA 1:80. HIV serology and HSV PCR were negative. A second dose of benzathine penicillin was administered a week later, followed by 45 minutes of observation. After delivery at term, the neonate received 10 days of benzyl penicillin. Discussion Learning points: 1. Exclude syphilis in anyone with genital ulceration, particularly in pregnancy. 2. Consult Immunology for advice on desensitisation regimen. 3. Write a syphilis birth plan as recommended by new BASHH guidelines

Malignant syphilis

Malignant syphilis

No improvement in serological response among serofast latent patients retreated with benzathine penicillin

Persistent non-treponemal titres after treatment are common among patients with latent syphilis. Although retreatment is often done in clinical practice, optimal management remains uncertain due to the paucity of data regarding serological response to retreatment and long-term outcomes. We compared the serological responses of serofast latent syphilis patients retreated with 7.2 million units of benzathine penicillin with the responses of patients who did not receive retreatment (control group). We retrospectively analysed the serological response to therapy following retreatment of 35 serofast latent syphilis patients at 12 months with benzathine penicillin 2.4 million units weekly for 3 weeks. In all, 74.3% (26/35) of the cases with latent syphilis who failed to achieve serological cure at 12 months after initial therapy achieved serological cure after retreatment and after an additional 12 months of follow-up. However, statistically similar serological cure rate was observed in 80.0% (28/35) of the control group (p > .05). Our findings illustrate no improvement in serological response among serofast latent patients retreated with three doses of benzathine penicillin.