Clinical Aspects of Syphilis Reinfection in HIV-Infected Patients

Courjon, Johan; Hubiche, T.; Dupin, Nicolas; Grange, P.; Giudice, P. Del

doi:10.1159/000369617

Cited by 29 publications

(24 citation statements)

References 16 publications

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“…More refined molecular methods such as multilocus sequence typing (MLST) or whole genome sequencing could perhaps be more conclusive [29]. We speculate that HIV could influence the clinical presentation of syphilis in a way similar to how immunological factors affect the manifestation of syphilis in patients with a history of syphilis [30].…”

Section: Discussionmentioning

confidence: 99%

Early syphilis: risk factors and clinical manifestations focusing on HIV-positive patients

et al. 2019

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Background Since 2000, substantial increases in syphilis in men who have sex with men (MSM) have been reported in many cities. Condomless anal sex (CAS) is one of the factors, along with drugs for sex and sex in group. This study identified factors and clinical manifestations as well as Treponema pallidum (T.pallidum) strains that could be related to early syphilis in Barcelona. Methods This prospective study was conducted in a sexually transmitted infections unit in 2015. Epidemiological, behavioral, clinical and microbiological variables were collected in a structured form. Univariate and multivariate statistical analyses were performed focusing on HIV-positive patients. Results Overall, 274 cases were classified as having early syphilis (27.5% primary, 51.3% secondary, and 21.2% early latent syphilis). In all, 94% of participants were MSM and 36.3% were HIV-positive. The median number of sexual contacts in the last 12 months was 10; 72.5% practiced CAS, 50.6% had sex in group, and 54.7% consumed drugs. HIV-positive cases had more anonymous sex contacts ( p = 0.041), CAS ( p = 0.002), sex in group ( p < 0.001) and drugs for sex ( p < 0.001). In the multivariate analysis, previous syphilis (adjusted odds ratio [aOR] 4.81 [2.88–8.15]), previous Neisseria gonorrhoeae infection (aOR 3.8 [2.28–6.43]), and serosorting (aOR 20.4 [7.99–60.96]) were associated with having syphilis. Clinically, multiple chancres were present in 31% of cases with no differences on serostatus, but anal chancre was most common in HIV-positive patients ( p = 0.049). Molecular typing did not conclusively explain clinical presentation in relation to specific T.pallidum strains. Conclusion Control of syphilis remains a challenge. Similar to prior studies, HIV-positive patients were found to engage more often in sexual behaviors associated with syphilis than HIV-negative patients. Clinical manifestations were rather similar in both groups, although anal chancre was most common in HIV-positive patients. Various strain types of syphilis were found, but no clinical associations were identified.

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Section: Discussionmentioning

confidence: 99%

Early syphilis: risk factors and clinical manifestations focusing on HIV-positive patients

et al. 2019

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“…This was indeed the finding of the only study whose design enabled it to compare the severity of clinical manifestations of syphilis in an intra-individual way. In a review of syphilis infections in an HIV-infected, single-center cohort in France over an 8-year period, detailed clinical notes including photographs were kept from each syphilis diagnosis, which enabled a more detailed and intra-individual comparison than the other studies could perform [ 5 ]. The study found that 78% of repeat infections were scored as less symptomatic than initial infections.…”

Section: Discussionmentioning

confidence: 99%

Repeat Syphilis Is More Likely to Be Asymptomatic in HIV-Infected Individuals: A Retrospective Cohort Analysis With Important Implications for Screening

Kenyon

Osbak

Apers

2018

Open Forum Infectious Diseases

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There is conflicting evidence as to whether repeat syphilis is more likely to present asymptomatically than initial syphilis. If it is, then this would motivate more frequent and long-term syphilis screening in persons with a history of multiple episodes of syphilis. We conducted detailed folder reviews of all individuals with 4 or more diagnoses of syphilis between 2000 and 2017 at the Institute of Tropical Medicine, Antwerp, and assessed if there was a difference in the proportion presenting with symptomatic (primary and secondary) vs asymptomatic (latent) syphilis in initial vs repeat syphilis. Forty-five clients with 4 or more episodes of syphilis were included in the study. All were HIV-infected. Repeat episodes of syphilis were less likely to be symptomatic than initial episodes (35/160 [21.9%] vs 28/45 [62.2%]; P < .001). Frequent screening in those with HIV infection may be the only way to diagnose repeat episodes of syphilis. Care providers can use this information to motivate persons with multiple episodes of syphilis to be screened every 3 to 6 months.

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“…Even after successful treatment, patients might still be re-infected by unprotected sexual contact. The re-infection rate of syphilis is high, especially among high-risk population [ 3 – 5 ]. For example, some studies in men who have sex with men (MSM) reported reinfection rates among this population ranging from 5.9 to 22% [ 6 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with syphilis treatment failure and reinfection: a longitudinal cohort study in Shenzhen, China

et al. 2017

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BackgroundThe treatment failure and reinfection rates among syphilis patients are high, and relevant studies in China are limited. The aim of this study was to detect the rates of treatment failure and reinfection after syphilis treatment and to explore the potential associated factors.MethodsWe conducted a longitudinal cohort study in a sexually transmitted disease clinic, the Department of Dermatology and Venereology in Nanshan Center for Chronic Disease Control. Serological testing was performed at baseline and throughout the 2-year follow-up for syphilis patients. To identify potential predictors of treatment outcomes, multivariate logistics analyses were utilized to compare the demographic and clinical characteristics of patients with serological failure/reinfection to those with serological cure/serofast.ResultsFrom June 2011 to June 2016, a total of 1133 patients were screened for syphilis. Among the 770 patients who completed the 2-year follow-up, 510 first-diagnosed patients were included in the final analysis. Multivariate logistics analysis revealed the stage of syphilis (secondary syphilis VS. primary syphilis: adjusted odds ratio, 3.50; 95% confidence interval, 1.11-15.47; p = 0.04), HIV status (positive VS. negative: adjusted odds ratio, 3.06; 95% confidence interval, 1.15-8.04; p = 0.02) and frequency of condom use (always use VS. never use: adjusted odds ratio, 0.28; 95% confidence interval 0.08-0.75; p = 0.02) were significantly associated with the serological outcome.ConclusionsThe clinical implications of our findings suggest that it is very important to perform regular clinical and serologic evaluations after treatment. Health counseling and safety education on sex activity should be intensified among HIV-infected patients and secondary syphilis patients after treatment.

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Clinical Aspects of Syphilis Reinfection in HIV-Infected Patients

Cited by 29 publications

References 16 publications

Early syphilis: risk factors and clinical manifestations focusing on HIV-positive patients

Early syphilis: risk factors and clinical manifestations focusing on HIV-positive patients

Repeat Syphilis Is More Likely to Be Asymptomatic in HIV-Infected Individuals: A Retrospective Cohort Analysis With Important Implications for Screening

Factors associated with syphilis treatment failure and reinfection: a longitudinal cohort study in Shenzhen, China

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