Human Immunodeficiency Virus Syphilis Research Articles

Syphilis-related Ocular Inflammation in HIV-positive and HIV-negative Patients

ABSTRACT Purpose To evaluate the clinical characteristics and visual outcomes of ocular syphilis in human immunodeficiency virus (HIV)-positive and negative patients. Methods We performed a retrospective chart review of all patients with newly diagnosed ocular syphilis between January 2015 and August 2021. Results 68 eyes of 41 patients (22 eyes in 12 HIV-positive patients, 46 eyes in 29 HIV-negative patients) were included. The most common ophthalmic feature was posterior uveitis in HIV-positive and anterior uveitis in HIV-negative patients; 58.3% (7 out of 12 patients) of HIV-positive and 48.2% (14 out of 29 patients) of HIV-negative patients were diagnosed with neurosyphilis. There were no significant differences in laterality, presence of concurrent rash, rapid plasma reagin (RPR) titers, presenting, and final corrected visual acuity between both groups. Conclusion Nearly one-fifth of eyes may suffer from severe visual loss of ≤ 20/200. HIV co-infection may not result in visual outcomes in syphilis.

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.

Diagnosis, Treatment, and Prognosis of Syphilis in HIV Patient

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum (T. Palladium). Human Immunodeficiency Virus (HIV) is a virus that attacks the body's immune system, decreased the number of CD4 cells that makes the immune system decrease, and facilitates syphilis infection. Syphilis increased the risk of spreading HIV infection with skin barrier destruction. The diagnosis of syphilis is made based on a complete history, including sexual history, clinical manifestations, and examination. The treatment of syphilis with HIV and without HIV similar, penicillin is still the gold standard for syphilis treatment with HIV. Prevention of syphilis with HIV are educated, screening for syphilis and other sexually transmitted infections, as well as early detection and therapy of partners. The prognosis for syphilis in HIV is worse than for syphilis without HIV.

Clinical characteristics, diagnosis, and predictors of neurosyphilis patients with human immunodeficiency virus co-infection: A retrospective study at infectious diseases hospitals in two cities of China.

This study aimed to compare between the clinical and laboratory characteristics of neurosyphilis and those of syphilis in human immunodeficiency virus (HIV) positive and explore the risk factors associated with the occurrence of neurosyphilis in the HIV infected.In-patients diagnosed with HIV and syphilis co-infection who underwent a lumbar puncture and completed cerebrospinal fluid (CSF) examination were divided into neurosyphilis group and syphilis group. The demographic characteristics, symptoms and signs, and laboratory tests of the 2 groups were comparatively analyzed. Logistic regression analysis was used to explore the risk factors associated with the occurrence of neurosyphilis.Among 81 patients, 33 patients were assigned to the neurosyphilis group, and 48 to the syphilis group. There were no significant differences in the age, gender, marital status, acquired immunodeficiency syndrome course, opportunistic infections, serum HIV viral load, and history of syphilis treatment. The difference in HIV transmission route between the 2 groups was statistically significant (P = .010), and the patients from the neurosyphilis group were mainly infected via heterosexual contact. The proportion of serum toludine red unheated serum test (TRUST) titer ≥1:16 in the neurosyphilis group were 78.8%, which was significantly higher compared to the syphilis group (48.9%). The level of CSF white blood cell count, CSF protein, and CSF HIV viral load in the neurosyphilis group were significantly higher than those of the syphilis group. The proportion of patients with neurological symptoms and signs in the neurosyphilis group was significantly higher compared to the syphilis group (P < .001). Multivariate logistic regression analysis showed that heterosexual contact transmission route, not received antiretroviral therapy, lower CD4 cell count and higher serum TRUST titer, untreated with syphilis, and neurological symptoms and signs were risk factors associated with the occurrence of neurosyphilis.The serum TRUST titer, CSF white blood cell count, CSF protein level, CSF HIV viral load, and the percentage of neurological symptoms and signs in the neurosyphilis group were higher. Heterosexual transmission route, not received antiretroviral therapy, and untreated with syphilis prompted the possibility of neurosyphilis occurrence.

Overlapping Primary and Secondary Syphilis in Human Immunodeficiency Virus (HIV) Patient

ABSTRACTCoinfection between syphilis and Human Immunodeficiency Virus (HIV) could have varied clinical manifestations. Overlapping of syphilis stages is accounted for 25% of cases, attributable to the defect of the cellular and humoral immune response. We reported 55 years old man who was sexually active since 25 years ago via genito-genital, genito-anal, genito-oral routes, had multiple sexual partners both male and female, seldom used condom, and always being the insertive. Dermatological examination revealed alopecia non-scarring, a painless solitary ulcer on the collum penis, also multiple erythematous macules, patches, and plaques all over the body. Spirochaeta sp. was found from the base of the ulcer with a darkfield microscope. Histopathology examination revealed secondary syphilis lesion. Venereal Disease Research Laboratory (VDRL) 1:16, Treponema Pallidum Haemagglutination test (TPHA) reactive, HIV Determine rapid test reactive, and CD4 (Cluster of Differentiation 4) T-cell count 111 cells/ µL. He was treated with a single dose of benzathine penicillin G 2,4 million units intramuscular and antiretroviral drugs. On sixth month evaluation, VDRL was non-reactive, and CD4 T-cell count 325 cells/µL. This case shows that overlapping clinical manifestations of primary and secondary syphilis on HIV patients could occur with a good general condition. Immediate treatment of antibiotics for syphilis and antiretroviral could improve the clinical and serological conditions.Keyword: primary syphilis, secondary syphilis, HIVCorrespondence: nurul.laili.nahlia@gmail.com

Secondary Syphilis in Human Immunodeficiency Virus (HIV)-Infected Men Who Have Sex with Men (MSM): A Case Report

Background: Recently, the incidence of syphilis among men who have sex with men (MSM) has increased rapidly, especially among Human Immunodeficiency Virus (HIV)-infected MSM. Coinfection with these two organisms alter the symptoms and signs, progression of the disease, and the risk of progressing to the tertiary stage. Purpose: To report a case of secondary syphilis in HIV-infected MSM. Case: A 24-year-old male complaint of multiple redness macule for 1-month duration on his chest, back, groin, palm, and soles. The rash was neither painful nor pruritic. He also complains of hair loss resulting "moth eaten" alopecia. One month before, he had a painless ulcer on his genital, which resolved without treatment. His HIV infection was diagnosed two years earlier. He had been sexually active with multiple homosexual partners without using a condom since 2010. The Venereal Disease Research Laboratory test (VDRL) titer was 1/32, and Treponema pallidum haemagglutination assay (TPHA) was 1/20480. Initial treatment was a single dose of 2.4 million units of benzathine penicillin. Serologic examination was reevaluated on month 1, 3, 6, and 9 after therapy and declined in the third month. Discussion: For HIV-infected persons, the clinical manifestations of syphilis in most of the cases remain the same. However, the lesions are more aggressive, and coexistence of primary and secondary syphilis is more frequent. Serologic tests are accurate and reliable for the diagnosis and for following a patient’s response to treatment. Penicillin is effective but physical and serological follow up is needed. Conclusion: HIV-infected MSM have higher risk of syphilis. Staging is needed to determine the treatment. Serologic examination should be repeated and long enough to monitor the treatment success.

Prevalence of Active Syphilis Infection and Risk Factors among HIV-Positive MSM in Zhejiang, China in 2015: A Cross-Sectional Study.

Objectives: To determine the prevalence of active syphilis infection and explore the risk factors for active syphilis in human immunodeficiency virus (HIV)-positive men who had sex with men (MSM) in Zhejiang Province, 2015. Design: Data on HIV-positive MSM living in Zhejiang Province were obtained from the National Center for AIDS/STD Control and Prevention (NCAIDS) reporting system and the Zhejiang provincial AIDS/STD surveillance system between June and December 2015. The information included risky behavior, years with diagnosed HIV, and highly active antiretroviral therapy (HAART). SPSS 19.0 was used for the data analysis. Results: The analysis included 3616 MSM. Of these, 11.3% (407/3616) had active syphilis. Multivariate logistic regression analysis revealed that HAART was significantly associated with an increased risk of active syphilis infection (odds ratio (OR) = 1.760, 95% confidence interval (CI) 1.187–2.611). Compared with participants diagnosed with HIV for <2 years, patients diagnosed with HIV for >5 years had a higher risk of active syphilis infection (OR = 1.707, 95% CI 1.167–2.495). Age and number of sex partners were also independent risk factors for active syphilis infection. Conclusions: The incidence of active syphilis infection is high among HIV-positive MSM in Zhejiang Province; age, number of sex partners, years with diagnosed HIV, and receiving HAART were risk factors. Patients who are elderly, have lived with HIV for a longer period, have more sex partners, and receive HAART should be the focus of interventions to promote changes in behavior and decrease syphilis infection.

Risk Factors and Incidence of Syphilis in Human Immunodeficiency Virus (HIV)-Infected Persons: The HIV Outpatient Study, 1999-2015.

Since 2000, the incidence of syphilis has been increasing, especially among gay, bisexual, and other men who have sex with men (MSM) in the United States. We assessed temporal trends and associated risk factors for newly diagnosed syphilis infections among human immunodeficiency virus (HIV)-infected patients during a 16-year period. We analyzed data from the HIV Outpatient Study (HOPS) cohort participants at 10 US HIV clinics during 1999-2015. New syphilis cases were defined based on laboratory parameters and clinical diagnoses. We performed Cox proportional hazards regression analyses of sociodemographic, clinical, and behavioral risk factors for new syphilis infections. We studied 6888 HIV-infected participants; 641 had 1 or more new syphilis diagnoses during a median follow-up of 5.2 years. Most participants were male (78%), aged 31-50 years, and 57% were MSM. The overall incidence was 1.8 (95% confidence interval [CI], 1.6-1.9) per 100 person-years (PY) and it increased from 0.4 (95% CI, .2-.8) to 2.2 (95% CI, 1.4-3.5) per 100 PY during 1999-2015. In multivariable analyses adjusting for calendar year, risk factors for syphilis included age 18-30 years (hazard ratio [HR], 1.3 [95% CI, 1.1-1.6]) vs 31-40 years, being MSM (HR, 3.1 [95% CI, 2.4-4.1]) vs heterosexual male, and being non-Hispanic black (HR, 1.6 [95% CI, 1.4-1.9]) vs non-Hispanic white. The increases in the syphilis incidence rate through 2015 reflect ongoing sexual risk and highlight the need for enhanced prevention interventions among HIV-infected patients in care.

Clinical manifestations and cerebrospinal fluid status in ocular syphilis in HIV-Negative patients.

BackgroundSyphilis with ocular involvement has reemerged as a critical health problem. The aim of the present study was to explore the clinical manifestations and cerebrospinal fluid (CSF) status in ocular syphilis in human immunodeficiency virus (HIV)-negative patients.MethodsThe clinical records of patients with ocular syphilis presenting to the Shanghai Xuhui Central Hospital in the period from January 2011 to December 2012 were retrospectively reviewed.ResultsThe median age of 25 HIV-negative patients with ocular syphilis was 53 years, 18 patients (72.0 %) were males and 7 (28.0 %) were females. None of them self-identified themselves as men who had sex with men (MSM). The ocular lesions included: uveitis (13 cases), optic neuropathy (6 cases), retinal vasculitis (5 cases), retinal detachment (3 cases), and neuroretinitis (4 cases). Serum toluidine red unheated serum test (TRUST) titer ranged from 1 to 512, with a median of 64. Overall, 18 (72.0 %) of the 25 patients had abnormal CSF results, 15 (60.0 %) CSF samples had elevated white blood cell counts, 13 (52.0 %) had elevated protein levels, and 9 (36.0 %) had reactive CSF Venereal Disease Research Laboratory (VDRL) test, respectively. Mann–Whitney U tests showed higher serum TRUST titer (>32) correlated with the abnormal CSF results.ConclusionsThe demographic characteristics of patients with ocular syphilis in this study were different from previous reports. The study showed a high CSF abnormal rate in HIV-negative patients. The recommendation for CSF examination from all patients with ocular syphilis, including HIV-negative cases, is strongly supported by the present data.

A single dose of benzathine penicillin G is as effective as multiple doses of benzathine penicillin G for the treatment of HIV-infected persons with early syphilis.

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. 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. 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]). 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.

Ocular Syphilis in Patients Infected With Human Immunodeficiency Virus

Uveitis secondary to syphilis in human immunodeficiency virus (HIV)-infected individuals is a well-documented but unusual phenomenon. We report the case of a 66-year-old man with HIV recently diagnosed with early latent syphilis coinfection who presented with an acute onset of ocular symptoms and whose condition was diagnosed as anterior uveitis. After administration of appropriate antibiotic therapy for syphilitic uveitis, his ocular symptoms resolved completely. We additionally provide a literature review on the presentation and management of syphilitic uveitis. This paper highlights the importance of considering syphilis in the differential of ocular symptoms, particularly in a patient with HIV, and also demonstrates that prompt evaluation and management are of paramount significance in an otherwise deleterious disease.

Preliminary assessment of Treponema pallidum-specific IgM antibody detection and a new rapid point-of-care assay for the diagnosis of syphilis in human immunodeficiency virus-1-infected patients

The aims of the study were to assess whether Treponema pallidum-specific IgM may provide a useful marker of infectious syphilis in human immunodeficiency virus (HIV)-infected patients, and to compare the performance of a prototype IgM-rapid point-of-care test (PoCT) with a standard IgM-enzyme immunoassay (EIA). Twenty samples from HIV-infected patients with untreated syphilis (n = 4 primary syphilis, n = 11 secondary and n = 5 early latent) and 51 follow-up samples at three, six or 12 months after treatment were tested for the presence of IgM with the Mercia-EIA (Microgen Bioproducts Ltd, Camberley, UK) and a prototype PoCT (Select Vaccines Ltd, Melbourne, Australia). Although sample numbers were small, IgM detection by EIA appears to be a reliable marker for untreated syphilis in HIV-infected patients with primary (4/4 IgM-positive) or secondary syphilis (10/11 IgM-positive, 1/11 equivocal). After treatment, IgM was no longer detected after three months in the majority of patients (87%) and was either negative or equivocal in all patients after six and 12 months. The overall sensitivity of the IgM-PoCT was 82% and varied with clinical stage, being highest in secondary (10/10 EIA positives) but lower in primary (2/4 EIA positives) and early latent syphilis (2/3 EIA positives). Overall specificity was 95%. Rapid detection of IgM would enable clinicians to distinguish between past-treated and infectious syphilis and allow for diagnosis and treatment in a single visit.

Symptomatic Relapse of Neurologic Syphilis after Benzathine Penicillin G Therapy for Primary or Secondary Syphilis in HIV-Infected Patients

We describe 3 symptomatic cases of neurologic syphilis that occurred after the administration of the usual therapy for primary or secondary syphilis in human immunodeficiency virus (HIV)-infected patients. We discuss the difficulty of diagnosing neurosyphilis, the need for lumbar puncture, and risk factors of relapse. Because HIV infection may alter the natural history and response of neurologic syphilis to treatment, scrupulous follow-up and repeated cycles of therapy are warranted.

HIV, HBV, HCV, and syphilis co-infections among patients attending the STD clinics of district hospitals in Northern India

The objective of the study was to assess the risk of co-infections with human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis among patients attending sexually transmitted disease (STD) clinics, antenatal clinics (ANC) and Ob-Gyn outpatients department (OPD) clinics which were part of the sentinel surveillance program. A serological screening was carried out during the period August-November 2002 to assess the risk of infection with HIV-1/2, and co-infection with HBV, HCV, and syphilis among the outpatients attending STD clinics, Ob-Gyn OPD clinics, and ANC of three district hospitals (Agra, Etawah, and Farrukhabad) of Uttar Pradesh state in Northern India. Unlinked and coded serum samples received from 863 patients (635 females and 228 males) were screened by laboratory tests commonly used for laboratory diagnosis of HIV, HBV, HCV, and syphilis. Among the 863 samples serological reactivity was detected for HIV-1/2 in 21 (2.4%), HBV in 25 (2.9%), HCV in nine (1.0%), and syphilis in 47 (5.4%). The incidence of HBV was higher among males than females, i.e. 10/228 (4.4%) versus 15/635 (2.4%). Co-infection was observed for HIV-HBV in two (0.2%), HBV-HCV in one (0.1%), and HIV-syphilis in one (0.1%). None were found to have co-infection with HIV-HCV, HBV-syphilis, and HCV-syphilis. Age, sex, literacy level, occupation, locality, migration, and presence of different sexually transmitted infections did not significantly influence the rate of HIV positives. A substantial percentage of the outpatients seen in the clinics of the district hospital in Uttar Pradesh harbor HIV and viral hepatitis infections, which otherwise would remain undiagnosed without serological screening.

A case of lues maligna in a patient with acquired immunodeficiency syndrome (AIDS)

We report a case of lues maligna (ulceronodular cutaneous syphilis) mimicking mycosis fungoides in an individual with AIDS and review the literature of this variant of syphilis in human immunodeficiency virus (HIV)-infected individuals. A comparison of the histological similarities and differences between lues maligna, late cutaneous syphilis and mycosis fungoides is also discussed.

Treatment of syphilis, 1993.

Data on treatment of patients with syphilis were reviewed in preparation for revision of the Sexually Transmitted Disease Treatment Guidelines of the Centers for Disease Control and Prevention. Published studies of treatment regimens available and practical for use today were reviewed, particularly in regard to the following issues: treatment for primary, secondary, and latent stages of syphilis; treatment for syphilis during pregnancy; treatment for syphilis in human immunodeficiency virus (HIV)-infected patients; and serological criteria for evaluating response to treatment. The results of treatment and the methodological quality of the studies was considered. Most treatment recommendations must be based on expert judgment and with reliance on the clinical experience over 4 decades. For the treatment of early syphilis in HIV-uninfected patients, this is probably sufficient. Data about HIV-infected patients are insufficient both for determining whether current therapy is adequate and for recommendation of an alternative if a change in therapy is deemed necessary.