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Occurrence, risk factors, diagnosis and treatment of syphilis in the prospective observational Swiss HIV Cohort Study

Thurnheer, Maria Christinea; Weber, Rainerb; Toutous-Trellu, Laurencec; Cavassini, Matthiasd; Elzi, Luigiae; Schmid, Patrickf; Bernasconi, Enosg; Christen, Anna Ba; Zwahlen, Marcelh; Furrer, Hansjakoba; the Swiss HIV Cohort Study

doi: 10.1097/QAD.0b013e32833bfe21
Clinical Science

Background: Annual syphilis testing was reintroduced in the Swiss HIV Cohort Study (SHCS) in 2004. We prospectively studied occurrence, risk factors, clinical manifestations, diagnostic approaches and treatment of syphilis.

Methods: Over a period of 33 months, participants with positive test results for Treponema pallidum hemagglutination assay were studied using the SHCS database and an additional structured case report form.

Results: Of 7244 cohort participants, 909 (12.5%) had positive syphilis serology. Among these, 633 had previously been treated and had no current signs or symptoms of syphilis at time of testing. Of 218 patients with newly detected untreated syphilis, 20% reported genitooral contacts as only risk behavior and 60% were asymptomatic. Newly detected syphilis was more frequent among men who have sex with men (MSM) [adjusted odds ratio (OR) 2.8, P < 0.001], in persons reporting casual sexual partners (adjusted OR 2.8, P < 0.001) and in MSM of younger age (P = 0.05). Only 35% of recommended cerebrospinal fluid (CFS) examinations were performed. Neurosyphilis was diagnosed in four neurologically asymptomatic patients; all of them had a Venereal Disease Research Laboratory (VDRL) titer of 1:≥32. Ninety-one percent of the patients responded to treatment with at least a four-fold decline in VDRL titer.

Conclusion: Syphilis remains an important coinfection in the SHCS justifying reintroduction of routine screening. Genitooral contact is a significant way of transmission and young MSM are at high risk for syphilis. Current guidelines to rule out neurosyphilis by CSF analysis are inconsistently followed in clinical practice. Serologic treatment response is above 90% in the era of combination antiretroviral therapy.

aClinic for Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland

bDivision of Infectious Diseases, University Hospital and University of Zurich, Zurich, Switzerland

cDivision of Dermatology and Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland

dDivision of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland

eDivision of Infectious Diseases, University Hospital of Basel, Basel, Switzerland

fDivision of Infectious Diseases, Cantonal Hospital of St-Gallen, St-Gallen, Switzerland

gDivision of Infectious Diseases, Cantonal Hospital of Lugano, Lugano, Switzerland

hInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

Received 8 February, 2010

Revised 7 May, 2010

Accepted 10 May, 2010

Correspondence to Hansjakob Furrer, MD, Universitätsklinik für Infektiologie, University Hospital Bern, Inselspital PKT2 B, CH-3010 Bern, Switzerland. Tel: +41 31 632 27 45; fax: +41 31 632 31 76; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.