Seventh International Congress on Drug Therapy in HIV Infection Glasgow, UK - 14-17 November 2004

Int Cong Drug Therapy HIV 2004 Nov 14-18;7:Abstract No. PL9.4

Fiona Mulcahy
Department of Genito-Urinary Medicines and Infectious Diseases, St. James's Hospital, Dublin, Ireland

WHO estimates approximately 12 million new cases of syphilis each year, the majority occurring in the developing world. In the last four years, however discrete outbreaks of syphilis have been reported in North America, United Kingdom, Ireland and Western Europe, where previous rates had been relatively low. These have occurred in MSMs with high-risk sexual behaviour, high rates of partner change, low condom use and frequent use of drugs around the time of sexual activity.

Syphilis and HIV infection have demonstrated epidemiological synergy, in which each infection facilitates the transmission of the other. Outbreaks in the US and Europe have reported rates of co-infection between 20% and 70% in MSM.

The clinical presentation of syphilis in HIV infected patients may be atypical with more protracted and malignant constitutional symptoms, unusual skin manifestations/rashes wider organ involvement and a more rapid progression to neurosyphilis. The diagnosis of syphilis is usually based on serological testing. However in HIV co-infected patients, unusual serological responses have been reported including an absent antibody response or high antibody titres. The diagnosis of neurosyphilis is also more challenging with CSF pleocytosis and elevated protein a common feature of HIV infection alone.

The drug of choice for the treatment of syphilis is penicillin with no documented reports of penicillin resistance to date. However there have been several reports of treatment failure in HIV infected patients and the efficacy of alternative oral therapy with doxycycline, tetracycline or macrolide regimens has not been adequately studied. More recently macrolide resistance in T pallidum has been reported in the US and Ireland. Careful clinical and serological follow up is essential to monitor response to treatment in HIV co- infected patients. Screening for syphilis should be offered to all HIV infected patients based on an adequate and regular risk behaviour assessment.

SESSION 9: HIV-RELATED INFECTIONS, CO-INFECTIONS AND MALIGNANCIES
2004-11-14
PL9.4

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