Despite reports of unusual clinical presentations and therapeutic responses among HIV-infected patients with syphilis, syphilis has not been regarded as a serious opportunistic infection that predictably progresses among most HIV-coinfected patients.
To define and describe differences in the presentation and response to treatment of early syphilis among HIV-infected and HIV-uninfected patients, to describe any differences by gender, and to determine if clinical presentation of central nervous system involvement predicted serologic failure.
A prospective, multicenter, randomized, controlled trial of enhanced versus standard therapy to compare the benefit of enhanced therapy, the clinical importance of central nervous system involvement, and the clinical manifestations of early syphilis infection among HIV-infected and HIV-uninfected patients.
The median number of ulcers was significantly greater among HIV-infected and HIV-uninfected patients, as was the percent of HIV-infected patients with multiple ulcers. Among patients diagnosed with secondary syphilis, a higher percentage of HIV-infected patients presented with genital ulcers [13/53 (25%)] than did HIV-uninfected patients [27/200 (14%)]. No differences between HIV-infected and HIV-uninfected patients were detected for other secondary syphilis manifestations. Although women presented more frequently with secondary syphilis than did men, no other gender differences in clinical manifestations were noted. Neurologic complaints were reported most frequently among patients with secondary syphilis [103/248 patients (42%)] compared with patients with primary syphilis [32/136 (24%)] and early latent syphilis [48/142, (34%)] (P < 0.05), but no differences in neurologic complaints were apparent by HIV status or CSF abnormalities. No neurologic complaints were significantly associated with serologic treatment failures at 6 months.
Overall, HIV infection had a small effect on the clinical manifestations of primary and secondary syphilis. Compared with HIV-uninfected patients, HIV-infected patients with primary syphilis tended to present more frequently with multiple ulcers, and HIV-infected patients with secondary syphilis presented with concomitant genitals ulcers more frequently.
From the *Johns Hopkins School of Medicine, Baltimore, Maryland; the †Centers for Disease Control and Prevention, Atlanta, Georgia; the ‡Medical College of Pennsylvania/Hahnemann University, Philadelphia, Pennsylvania; the §SUNY Health Sciences Center at Brooklyn, Brooklyn, New York; and the ⌆Department of Medicine and Microbial Pathogenesis, University of Connecticut Health Center, Farmington, Connecticut
Reprint requests: Anne M. Rompalo, MD, ScM, Division of Infectious Diseases, Johns Hopkins University, 1830 East Monument St., Rm. 435A, Baltimore, MD 21287-0003.
Received for publication April 19, 2000,
revised August 7, 2000, and accepted August 8, 2000.
Members of the Syphilis and HIV Study Group include: Deborah D’Aquilante, MD, Pamela French, MD, Marla J. Gold, MD, Deborah Hildebrandt, Edward F. Hindershot, MD, Judith A. O’Donnell, MD, and Marguerite A. Urban, MD (City of Philadelphia Department of Public Health and Medical College of Pennsylvania/Hahnemann University, Philadelphia, PA); Edward W. Hook, III, MD, Cindy Reichart, MT, Anne M. Rompalo, NMD, and Jonathan M. Zenilman, MD (Baltimore City Health Department and The Johns Hopkins University School of Medicine, Baltimore, MD); Michael H. Augenbraun, MD, William M. McCormick, MD, and Barry Smith, PA-C (SUNY Health Sciences Center at Brooklyn, Brooklyn, NY); Michael Chiu, MD, Martin Goldberg, Justin D. Radolf, MD, Eric Steen, MD, and Diane Turner (University of Texas, Southwestern Medical Center, Dallas, TX); Lydia Bayne, MD, Gail Bolan, MD, Joseph Engelman, MD, Jennifer Flood, MD, and Sandra Schwarz, MD, MPH, (San Francisco Department of Public Health, San Francisco, CA); Charles B. Hicks, MD, and Steven C. Johnson, MD (Walter Reed Army Medical Center [WRAMC], Washington, DC); Mark Htoo, MD, and Ramona Vitkevich, MD MPH., (New York City Department of Public Health, New York, NY); Howard A. Stark, MD, and Kenneth F. Wagner, DO (National Naval Medical Center [NNMC], Bethesda, MD); Sandra Larsen, PhD, and Victoria Pope, PhD (Division of STD Laboratory Research, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA); William E. Brady, MPH, PA-C, Sue Goforth, M. Riduan Joeseof, MD, PhD, Robert Johnson, MD, MPH, and Robert T. Rolfs, MD, Principal Investigator (Division of STD/HIV Prevention, National Center for Prevention Services, Centers for Disease Control and Prevention, Atlanta, GA); William Alexander, MD, Sheila A. Lukehart, PhD, Laurence Magder, PhD, Data Safety Monitoring Committee.