Syphilis treatment in the presence of HIV: the debate goes on.

Abstract:

PURPOSE OF REVIEW:Benzathine Penicillin G has been used to treat syphilis for over 50 years; however, the precise regimen of penicillin for treatment of syphilis in HIV-positive individuals remains a hot topic of debate. Although international guidelines recommend the same treatment for syphilis, regardless of HIV status, there are inconsistencies in prescribing practices among clinicians. RECENT FINDINGS:Two previous systematic reviews have found limited evidence for enhanced treatment of syphilis in the presence of HIV. However, a growing body of literature indicates that the rate of asymptomatic neurosyphilis may be higher in HIV, and that syphilis infection is associated with poorer long-term neurocognitive outcomes. A number of retrospective studies propose that serological response may be slower, or serological failure may be higher, among HIV-positive individuals, but these studies are limited by high loss to follow-up, high reinfection rates and a focus on serological rather than clinical response. Beyond penicillin, some evidence suggests equivalence of macrolides, cephalosporins and doxycycline, although macrolide resistance is an increasing concern. SUMMARY:Until a prospective, randomized study is conducted, inconsistency with treatment will continue. We offer a pragmatic approach to recognizing patients who may require further investigation or neuropenetrative antibiotic treatment.

journal_name

Curr Opin Infect Dis

authors

Lawrence D,Cresswell F,Whetham J,Fisher M

doi

10.1097/QCO.0000000000000132

subject

Has Abstract

pub_date

2015-02-01 00:00:00

pages

44-52

issue

1

eissn

0951-7375

issn

1473-6527

pii

00001432-201502000-00008

journal_volume

28

pub_type

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