Failure of erythromycin to cure secondary syphilis in a patient infected with the human immunodeficiency virus

Duncan, W. C.

doi:10.1001/archderm.125.1.82

Cited by 7 publications

(5 citation statements)

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“…Erythromycin is not recommended because it frequently fails to eradicate syphilis in both the mother and the fetus. [68][69][70] Tetracycline, the only other agent that has been proved eVective, is not recommended because of dental staining and impairment of long bone growth in the fetus and hepatotoxicity when given intravenously (to a pregnant women with coexisting renal insuYciency). 65 InsuYcient data exist to recommend azithromycin or ceftriaxon for treatment of syphilis during pregnancy.…”

Section: Treatmentmentioning

confidence: 99%

Syphilis in pregnancy

Genç¹

2000

Sexually Transmitted Infections

171

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Syphilis can seriously complicate pregnancy and result in spontaneous abortion, stillbirth, nonimmune hydrops, intrauterine growth restriction, and perinatal death, as well as serious sequelae in liveborn infected children. While appropriate treatment of pregnant women often prevents such complications, the major deterrent has been inability to identify the infected women and get them to undergo treatment. Screening in the first trimester with non-treponemal tests such as rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL) test combined with confirmation of reactive individuals with treponemal tests such as the fluorescent treponemal antibody absorption (FTA-ABS) assay is a cost eVective strategy. Those at risk should be retested in the third trimester. Treatment during pregnancy should be with penicillin. In determining a penicillin regimen, the clinician must consider the stage of the maternal infection and the HIV status of the mother. Patients who are allergic to penicillin should be desensitised before treatment. Despite appropriate treatment, as many as 14% will have a fetal death or deliver infected infants. Treatment may further be complicated by the Jarich-Herxheimer reaction, a complex allergic response to antigens released from dead micro-organisms, which can cause fetal distress and uterine contractions. Thanks to eVective intervention strategies and inexpensive penicillin, syphilis rarely complicates pregnancy in the Western world today. In parts of the world where the traditional sexually transmitted diseases have not been controlled, the magnitude of problems associated with syphilis during pregnancy is reminiscent of that faced by the West during the early 1900s. (Sex Transm Inf 2000;76:73-79)

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Section: Treatmentmentioning

confidence: 99%

Syphilis in pregnancy

Genç¹

2000

Sexually Transmitted Infections

171

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“…Such changes in the presentation and epidemiology of STDs would further facilitate the heterosexual transmission of HIV. Apparently, HIV infection results in decreased responsiveness to standard therapy among persons with chancroid (7,54) and early infection with syphilis (5,25,40). Atypical presentation with both chancroid and syphilis in the presence of HIV infection, including larger and extragenital lesions, have also been reported (4,11,50,76).…”

Section: The Role Of Other Stds In the Acquisition Of Hiv Infection Tmentioning

confidence: 99%

Heterosexual Transmission of HIV: The Role of Other Sexually Transmitted Infections and Behavior in Its Epidemiology Prevention and Control

Aral¹

1993

Annu. Rev. Public Health

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“…Alternative antibiotics for nonpregnant penicillin-allergic patients with primary or secondary syphilis include doxycycline, tetracycline, or erythromycin. Erythromycin treatment failures have been documented in patients with primary or secondary syphilis and infants with congenital syphilis (2,3,5). We previously demonstrated high-level erythromycin resistance (Erm r ) in a T. pallidum clinical isolate (Street strain 14) obtained from a syphilis patient who failed erythromycin therapy (11).…”

mentioning

confidence: 98%