HIV Syphilis Research Articles

Modeling Syphilis and HIV Coinfection: A Case Study in the USA.

Syphilis and HIV infections form a dangerous combination. In this paper, we propose an epidemic model of HIV-syphilis coinfection. The model always has a unique disease-free equilibrium, which is stable when both reproduction numbers of syphilis and HIV are less than 1. If the reproduction number of syphilis (HIV) is greater than 1, there exists a unique boundary equilibrium of syphilis (HIV), which is locally stable if the invasion number of HIV (syphilis) is less than 1. Coexistence equilibrium exists and is stable when all reproduction numbers and invasion numbers are greater than 1. Using data of syphilis cases and HIV cases from the US, we estimated that both reproduction numbers for syphilis and HIV are slightly greater than 1, and the boundary equilibrium of syphilis is stable. In addition, we observed competition between the two diseases. Treatment for primary syphilis is more important in mitigating the transmission of syphilis. However, it might lead to increase of HIV cases. The results derived here could be adapted to other multi-disease scenarios in other regions.

A cross-sectional descriptive study of clinical and serological prevalence of syphilis infection in people living with HIV and its effect on CD4+ T cells.

Context:The natural history of syphilis could be altered in the presence of HIV. It has been documented that syphilis infection increases the risk of HIV transmission by at least 3-fold.Aims:The aim of the study was (1) to study clinical presentation of syphilis in HIV individuals, (2) to estimate seroprevalence of syphilis in HIV individuals, and (3) to study the effect of syphilis infection on CD4+ T cells.Subjects and Methods:HIV-positive patients attending sexually transmitted infection clinic for a period of 1 year from June 2017 to May 2018 in the age group of 15–70 years were included in the study. A detailed history was taken; genital and dermatological examination was done. All patients were tested with VDRL and treponema pallidum hemagglutination assay (TPHA). Pearson's Chi-square test was used to compare categorical variables and Student's t-test was used to compare continuous variables.Results:Out of ninety study population, nine (10%) had clinical manifestations of syphilis. VDRL was positive with significant titers in all cases of syphilis. TPHA was positive in 88.9% of cases with clinical syphilis and 17.3% of cases without clinical manifestations of syphilis. Mean CD4 count was low among patients having syphilis infection compared to study population.Conclusion:This study shows high prevalence of syphilis in HIV and highlights the importance of preventing and promptly treating syphilis in people living with HIV, as the active infection is associated with fall in CD4 count, which leads to opportunistic infections.

2273. Neurosyphilis in Pacients With HIV Infection: Clinical Presentation of 94 Cases

BackgroundSyphilis remains highly prevalent, particularly in men with HIV infection (HIV+), in whom atypical manifestations and neurosyphilis (NS) are frequent. NS may be asymptomatic and IM benzathine penicillin treatment is ineffective. Although ideal-but not practical-all cases of syphilis in HIV+ patients (patients) should have CSF study to rule out NS. The objective of this study was to quantify and characterize NS cases in HIV+ patients with syphilis.MethodsRetrospective study from 01-02-2013 to 04-30-2018 at Fundación Arriarán in Santiago, Chile of 618 coinfected patients with CSF study due to neurological, visual or auditory symptoms, or serum VDRL ≥ 1:32. Any positive VDRL titer in CSF was considered demonstrated NS (dNS) and isolated pleocytosis ≥ 20 cells/μL considered probable NS (pNS). Status of HIV infection, syphilis, CSF analysis, NS treatment, and follow-up were characterized.ResultsNS was diagnosed in 94/618 patients (15.2%) with CSF study, (3 women), 80.8% were dNS and 19.2% pNS. Median age was 32 years (range 20–67); median CD4 cell count was 317 cells/μL (IQR of 188–473). In 41.5% NS was diagnosed at entry into care; syphilis was classified as primary in 2.1%, secondary in 22.3%, early–latent in 29.8% and late latent in 45.8%. Most cases of NS (84%) were neurologically asymptomatics (88.8% in pNS). Median CSF leukocytes in dNS was 5 cells/μL (range 0–338), and in pNS 31 cells/μL (range 16–90). Treatment was with IV ceftriaxone in 57/94 (60.6%), and in 39.4% with IV sodium penicillin. Follow-up data with serum VDRL at 3, 6 and 12 months were obtained in 44/94 (41.4%), 37.6% and 24.4% of patients respectively, who presented a decrease of 2-fold serum VDRL in 35/44 (79.5%), 82.5% and 92.3% with data, according to baseline, respectively.ConclusionNS is an important complication of syphilis in HIV+ patients; and it should be suspected and actively investigated throughout their care given the high rate of asymptomatic status, even in NSd. Positivity of VDRL in CSF is associated with more symptoms. Ceftriaxone is an alternative therapy, but that requires larger and longer prospective studies for confirmation. The decrease of 2-fold serum VDRL in 6 months may predict treatment success. The role of CSF study post treatment to evaluate this outcome and the criteria for cure have not been well established.Disclosures All authors: No reported disclosures.

Prevalence of HIV infection and syphilis and related behaviors in clients in Ya'an of Sichuan province

Objective: To understand the prevalence of HIV infection and syphilis in clients in Ya'an of Sichuan province. Methods: A survey was conducted in clients recruited through snowball method in Ya'an of Sichuan from April 2014 to December 2015. The information of the clients, including basic demography characteristics, AIDS knowledge awareness, high-risk behaviors and others, were collected through face-to-face interviews. Blood sample (5 ml) was taken from each client to test antibodies against HIV and syphilis. Statistical software SPSS 18.0 was used for data analysis. Results: Among the 708 clients, the constituent ratio of those aged ≥50 years was 51.27% (363/708), those in Han ethnic group was 99.72% (706/708), those with junior high school educational level or below was 90.11% (638/708), those who got married or cohabitated with others was 74.15% (525/708), and those who used condoms at each sex was 27.40% (194/708). Seven HIV positive cases were detected and 4 cases were aged ≥50 years. Seven syphilis cases were detected and all the cases were aged ≥50 year. No HIV-syphilis co-infection case was detected. The prevalence of HIV infection and syphilis were all 0.99% (95%CI: 0.30%-1.70%). Results from the multivariate logistic regression analysis showed that the clients who had their first commercial sex behavior at age <30 years (OR=6.61, 95%CI: 1.09-40.18) would have higher HIV positive rate. Conclusion: The rate of condom use was low in the clients in Ya'an and they didn't pay enough attention to their self-protection in sexual activities. Especially the clients aged ≥50 years were with low educational level and had high risk commercial sexual behaviors for HIV infection and syphilis. Close attention needs to be paid to them.

P148 An audit on management of aftercare for victims of sexual assault attending a dedicated aftercare clinic

Background/introduction A dedicated sexual assault aftercare clinic was set up at the integrated sexual health service to provide care for the victims of sexual assault. British Association for Sexual Health and HIV (BASHH) guidelines provide auditable measures to compare standard of care provided by services. We wanted to assess and improve the service offered to victims by the dedicated clinic. Aim(s)/objectives To evaluate current clinical practice in the management of victims of sexual assault against the auditable outcome measures in the guidelines and improve the quality of care provided by communicating the findings, recommendations and action plans to team members. Methods Retrospective review of all victims who attended the clinic between January 2015 and 31st September 2015 was performed. Cases were identified from coding used in the clinic. A standard data collection sheet developed on the basis of the BASHH guidelines was used. Results Of the 53 victims identified, 96% were women, 83% were white, 13% were alcohol/drug related and 25% were under 18 years of age. 57% were referred by the sexual assault referral centre.96% reported one assailant and 55% were known to the victim. 100% had HIV risk assessment and were offered PEPSE if indicated. 98% were offered forensic examination if applicable, 93% emergency contraception if needed. Offer of prophylaxis against sexually transmitted infections: chlamydia 74%, gonorrhoea 62%, Trichomonas 49%. Offer of baseline testing for chlamydia 98%, gonorrhoea 100%, trichomonas 64%, syphilis HIV and hepatitis B & C 100%. Documentation of a plan for repeat STI testing 93%, documentation of offer of vaccination against hepatitis B 94% and assessment of child protection needs if under 18 years 77%. Discussion/conclusion Areas to improve: documentation of a self-harm risk assessment, offer of emergency contraception, recording of a discussion of need for pregnancy test in 3 weeks after emergency contraception, documentation of offer of prophylactic treatment for chlamydia, gonorrhoea and trichomonas and documentation of an assessment of child protection needs if the victim was under 18 years of age. This will be re-audited in 6 months.

Secondary syphilis in HIV

Secondary syphilis in HIV

Management of syphilis in HIV-positive individuals.

Since the turn of the millennium a sustained outbreak of syphilis among men who have sex with men continues, approximately 20-50% of whom have concurrent HIV infection. In this paper we aim to explore the controversies that exist around the management of syphilis in HIV-positive individuals. Not only do HIV-positive people have different clinical manifestations of syphilis they have higher rates of asymptomatic neurological involvement, slower serological response to treatment and higher serological failure than HIV-negative individuals in most studies. Whether long-term clinical outcomes are different or affected by the antibiotic regimen selected remains to be established. The optimal antimicrobial regimen to treat syphilis in HIV is unknown due to a dearth of randomised controlled trial data. International guidelines state that the antibiotic management of syphilis is the same regardless of HIV status, with early syphilis treated with a single dose of benzathine penicillin G 2.4mU intrmuscularly. In practice, however, the majority of surveyed clinicians do treat HIV-positive people with more intensive antibiotics suggesting a lack of faith in guidelines. Factors which appear to affect the likelihood of developing neurological disease include CD4(+) count of <350 cells/μL, absence of antiretroviral therapy, rapid plasma regain (RPR) or venereal diseases reference laboratory titre (VDRL) >1:32, late-latent disease or lack of response to standard antibiotic treatment. We recommend a low-threshold for offering antibiotic treatment effective against neurosyphilis in HIV-positive people with syphilis, especially if they exhibit any of the above factors.

Diffuse Hair Loss in Secondary Syphilis in HIV Positive Man: Case Report

SUMMARY Hair loss is not a common feature of secondary syphilis. There are two types of syphilitic alopecia: “symptomatic” type where hair loss is associated with other symptoms of secondary syphilis, and “essential” alopecia that is either patchy (“moth-eaten” type), diffuse pattern with a generalized thinning of the scalp hair, or a combination of both without any other mucocutaneous signs of syphilis. This article presents a case of syphilitic alopecia in a 30-year-old homosexual man. The patient had diffuse non-scarring alopecia of his scalp and loss of eyelashes and eyebrows. A macular rash with palmar-plantar involvement and oral lesions coexisted with the hair loss. Serological tests for syphilis were positive. The patient was treated with a single dose of benzathine penicillin G, 2.4 million units intramuscularly. Within three months there was dramatic hair regrowth, and all syphilitic lesions resolved. Patient was councelled and tested on HIV. The HIV seropositivity was confirmed by Western blot analysis. Syphilitic alopecia should not be overlooked in patients with non-scarring hair loss. Serologic testing for syphilis is recommended in patients with unexplained rapid hair loss. However, all patients presenting with syphilis should be offered HIV testing.

Ocular Syphilis in HIV-Positive Patients Receiving Highly Active Antiretroviral Therapy

Background From October 2001 to October 2002, we have observed a surprisingly high incidence of ocular syphilis in human immunodeficiency virus-positive (HIV+) patients receiving highly active antiretroviral therapy at our clinic. Methods We conducted a retrospective chart and patient database review. Results From 1997 to 2002, 455 patients in our clinic were screened for syphilis; 320 were screened from 2001 to 2002; 7.3% of patients (33/455) were diagnosed with syphilis. During the past year, syphilis was diagnosed in 7.5% of patients (24/320), of whom 13% (3/24) had ocular syphilis. We estimate the prevalence of ocular syphilis in HIV+ patients on highly active antiretroviral therapy screened for syphilis to be 9% (3/33). Presenting symptoms included blurred vision, loss of vision, central scotomas, and bilateral ocular involvement. The most common ocular manifestation of syphilis was posterior chamber uveitis; one patient also had a retinal detachment. All patients demonstrated reactive rapid plasma reagin and fluorescent treponemal antibody absorption test results, cerebrospinal fluid pleocytosis, and elevated total protein. Each patient received a 21-day course of intravenous penicillin G (24 million units daily) with improvement of visual symptoms. Conclusion Our data demonstrate an unexpectedly high incidence of ocular syphilis in our HIV+ patients receiving highly active antiretroviral therapy during the past year. A diagnosis of ocular syphilis should be considered in any HIV+ patient who presents with visual symptoms, irrespective of the patient’s CD 4 count.

Making sense of syphilis: beliefs, behaviours and disclosure among gay men recently diagnosed with infectious syphilis and the implications for prevention

The resurgence of syphilis in men who have sex with men (MSM) has proved remarkably resilient in the face of innovative control and prevention interventions. Understanding the determinants of the current outbreaks has been restricted by the available data. Qualitative work is needed to understand individual and community experiences of syphilis and to help guide new prevention and control efforts. An exploratory study using semi-structured interviews with a convenience sample of MSM (n = 15), recently diagnosed with infectious syphilis, attending sexual health and HIV-outpatient services in Brighton, England. Analysis focussed on men's beliefs about syphilis, their experience of testing and being given a syphilis diagnosis, mediators of 'risky' sexual behaviour and disclosure to social and sexual contacts. Two beliefs--'syphilis is rare' and 'syphilis is dirty'--dominated respondents' accounts. These beliefs coloured every aspect of respondents' clinical and social experience of syphilis, and impeded disclosure and partner notification. They also contributed to misconceptions about behaviours with increased syphilis transmission risk, the mechanics of disease acquisition, health-seeking behaviours and risk-reduction strategies. The apparent failure of syphilis control measures so far may be due to our limited understanding of MSM's views and experience of STIs other than HIV Syphilis prevention needs to tackle MSM's widely held beliefs about sexual communication, risk behaviour and other STIs. The most useful health education interventions are likely to be those that build on MSM's significant knowledge base and address both the current syphilis crisis and wider sexual health promotion goals.

Reproductive Tract Infections and Women's Health

The incidence and consequence of genital infections in women especially in developing countries including AIDS genital cancers pelvic inflammatory disease ectopic pregnancy poor pregnancy outcomes and infections in neonates are reviewed. The sexually transmitted diseases (STDs) are less symptomatic more difficult to diagnose more easily contracted and have more serious and life-threatening consequences for women than they do for men. Facilities for treatment are few and may cater to men. Fatal consequences include ectopic pregnancy septic abortion or puerperal sepsis and cervical cancer; abuse and ostracism may result from infertility; blaming her contraceptive the woman may discontinue. The few available data suggest that STDs are more common in Africa moderate in South America and less common in Asia. AIDS is most prevalent to be spreading rapidly in Thailand South America and urban areas of India. Cervical cancer accounts for 3-5% of cancer deaths in the women of many developing countries peaks at ages 30-40 and becomes invasive in only 10 years. It is associated with certain strains of human papilloma virus the causative agent of genital warts and appears to progress faster in HIV-infected women. Probably a single Pap smear in this age group would detect 50% of all cervical cancers. Pelvic inflammatory disease is multi-causal often polymicrobial and difficult to diagnoses. It may be asymptomatic or eventually cause chronic pain ectopic pregnancy and infertility. In the absence of prevalence data measures of lifetime or 10-year infertility give estimates of the incidence of PID. Ectopic pregnancy also has no prevalence data. Fatality rates range from 3.4/10000 in the U.S. to 10.5/10000 hospitalized cases in Nigeria. The whole range of adverse pregnancy outcomes miscarriage stillbirth premature or prolonged rupture of the membranes chorioamnionitis septic abortion prematurity and growth retardation have all been related to various STDs including gonorrhea syphilis chlamydia herpes trichomoniasis and cytomegalovirus. Neonatal infections are attributed to gonorrhea syphilis HIV herpes and group B streptococcus. This broad list of adverse effects of STDs ranging from social stigma to pain and death suggest that STDs place a great burden on women. STD treatment in family planning programs would be a way to reach sexually active women while supporting their desire to bear wanted children.