Diagnosis and Management of Syphilis in Patients With HIV Co-infection
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HIV Medicine (C Yoon, Section Editor)
Diagnosis and Management of Syphilis in Patients With HIV Co-infection Carole Khaw, MBBS, DFSRH (UK), FRACGP, PG Cert Pub Hth. (Sex. Hth), FAChSHM, AFANZAHPE1,2,* Catherine Malden, MBBS1 Mahesh Ratnayake, MBBS, Dip. Ven, MD, FAChSHM1 Mark Boyd, MD, FRACP2 Address 1 Adelaide Sexual Health Centre, Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia *,2 Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, 5005, Australia Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on HIV Medicine Keywords Syphilis/HIV co-infection I Atypical manifestations I Diagnosis I Management I Neurosyphilis I Benzathine penicillin
Abstract Purpose of review Syphilis cases are on the increase especially in men who have sex with men (MSM) in urban areas of high-income countries. There is a strong association between syphilis and HIV infections. We review the more recent literature regarding the epidemiology, clinical manifestations, diagnostic investigations, treatment and follow-up of syphilis in HIV infection. Recent findings Although the clinical manifestations of syphilis in people living with HIV (PLHIV) and HIV-uninfected patients are broadly similar, differences have been described in PLHIV. Asymptomatic primary syphilis and secondary syphilis are more common in PLHIV as well as several atypical and severe syphilis presentations. Asymptomatic and symptomatic neurosyphilis are also more commonly described in the HIV infected. The use of penicillin regimes remains the mainstay of treatment, although there is evidence of the successful use of non-penicillin-based regimes, e.g. doxycycline. Summary Syphilis infections in PLHIV are common and increasing. A low index of suspicion and testing with appropriate, rapid treatment should decrease the significant morbidity associated with this infection.
HIV Medicine (C Yoon, Section Editor)
Introduction Since the turn of the century, syphilis has increased in high-income countries especially in the Western world [1–5]. The dominant demographic of the syphilis epidemic has been in men who have sex with men (MSM) in urban areas [6]. HIV co-infection has been demonstrated to be strongly associated with syphilis [7, 8]. The increasing number of syphilis cases in people living with HIV (PLHIV) has been reported [9]. PLHIV are 8 times more likely to be infected with syphilis [10]. HIV coinfection rates between 2003 and 2013 in Barcelona, Spain, were 30% [11]. In Australia, it was reported that the incidence of syphilis in HIV-positive men between 2010 and 2015 increased by 38% [12]. Greater than 25% of all new syphilis infections occurred in MSM co-infected with HIV in Alberta, Canada [13]. HIV and syphilis infections appear to be related [14, 15]. Syphilis itself could increase the risk of HIV infection [16]. Syphilis and HIV transmission synergy
occurs but it remains controversial as to wh
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