Darcy Wooten, MD, MS, Charles B. Hicks, MD reviewing Andrade R et al. Clin Infect Dis 2017 Mar 15.

A single dose of intramuscular benzathine penicillin G was as effective as three weekly doses.

Syphilis remains a major public health issue in the U.S., particularly among HIV-infected men who have sex with men. The most recent CDC treatment guidelines recommend a single dose of penicillin as treatment of early syphilis for patients with or without HIV infection, but some clinicians opt to treat HIV-infected individuals with three weekly doses instead.

In a prospective, open-label trial, investigators randomized 64 HIV-infected patients with early syphilis to receive either a single dose or three weekly doses of intramuscular benzathine penicillin G.

After 12 months of follow-up, serologic response rates, defined as a ≥4-fold decline in rapid plasma regain (RPR) titer (the primary outcome), were not significantly different between the single- and three-dose regimens by intention-to-treat analysis (80% and 93%, respectively) or by per-protocol analysis (93% and 100%). Also, no clinical-treatment failures or differences in response rates were seen between the single- and three-dose regimens when patients were stratified by baseline CD4 cell count (<350 or >350 cells/µL), HIV RNA, use of antiretroviral therapy, baseline RPR titer (<32 or >32), or stage of syphilis (primary, secondary, or early latent).

CITATION(S):

Andrade R et al. Single dose versus 3 doses of intramuscular benzathine penicillin for early syphilis in HIV: A randomized clinical trial. Clin Infect Dis 2017 Mar 15; 64:759.

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