Treatment for Early Syphilis in HIV-Infected Individuals — Once Is Enough

Keith Henry, MD reviewing Ganesan A et al. Clin Infect Dis 2015 Feb 15. Tuddenham S and Ghanem KG. Clin Infect Dis 2015 Feb 15.

Treatment response was good whether patients received one or multiple intramuscular injections of penicillin.

Syphilis in HIV-infected individuals prompts concerns about increased risk for neurosyphilis and decreased response to treatment. Now, using data from the U.S. Military Natural History Study, researchers have examined the efficacy of a single dose of penicillin for treating early syphilis in study participants.

Between 1986 and 2013, 619 cases met the criteria for early syphilis (i.e., seroconversion during the preceding 365 days using a nontreponemal test, confirmed with a treponemal test). The final analysis involved 478 cases of early syphilis in 350 participants (99% male, 63% African-American, 69% on antiretroviral therapy; median CD4 count, 494 cells/mm3) with information available on treatment used and pre- and posttreatment syphilis test results.

Of these 478 cases, 141 were treated with one dose — and 252 with two or more doses — of intramuscular benzathine penicillin. (Eighty-five were treated with other regimens, 70 of which included penicillin.) The 13- and 24-month treatment-response rates were 92% and 97%, respectively, and were the same for the single and multiple penicillin-dose regimens. In multivariate analysis, older age, lower CD4-cell counts, and lower pretreatment serology titers were associated with delayed treatment response.

Citation(s):

Ganesan A et al. 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. Clin Infect Dis 2015 Feb 15; 60:653.

Tuddenham S and Ghanem KG.The optimal dose of penicillin when treating syphilis in HIV-infected persons: Enough, already? Clin Infect Dis 2015 Feb 15; 60:661.