Investigating latent syphilis in HIV treatment-experienced Ethiopians and response to therapy

Abstract

Objectives We investigated people with HIV (PWH) receiving combination antiretroviral therapy (cART) for latent syphilis infection prevalence, risk factors, treatment response, and neurosyphilis. Methods A prospective follow-up study was conducted on PWH and latent syphilis. The cases were randomly assigned to receive either benzathine penicillin G (BPG) or doxycycline (DOXY), and the posttreatment response was evaluated after 12 and 24 months. The traditional algorithm was used for serodiagnosis, and a semi-quantitative rapid plasma reagin (RPR) test monitored disease activity and treatment effectiveness. Results Of the 823 participants, 64.8% were women, and the mean age was 41.7±10 years. Thirty-one (3.8%) of the participants (22 males and nine females) had latent syphilis. The risk factors were male sex (aOR = 3.14), increasing age (aOR = 1.04 per year), and cART duration (aOR = 1.01 per month). Baseline RPR titers were: ≤1:4 in 19 (61.3%), between 1:8 and 1:32 in 10 (32.2%), and >1:32 in 2 (6.4%). None of the seven cerebrospinal fluid analyses supported a neurosyphilis diagnosis. In the 12th month of treatment, 27 (87.1%) had adequate serological responses, three (9.7%) had serological nonresponse, and one (3.2%) had treatment failure. Syphilis treatment was repeated in the last four cases with the alternative drug. In terms of adequate serologic response, both therapies were comparable at the 12th month, p = 0.37. All cases responded to treatment in the 24th month. Conclusion In PWH receiving cART, latent syphilis occurred more in men than women, suggesting an investigation of sexual practices and the impact of antenatal syphilis screening. Syphilis disease activity reduces in the latent stage. Therefore, the routine cerebrospinal fluid analysis contributes little to the diagnosis of asymptomatic neurosyphilis and the treatment success of latent syphilis. DOXY is an alternative to BPG, and cART improves serologic response to latent syphilis treatment.

Prevalence and Treatment Outcomes of Syphilis among People with Human Immunodeficiency Virus (HIV) Engaging in High-Risk Sexual Behavior: Real World Data from Northern Greece, 2019–2022

“…Furthermore, approximately one-third of the study participants had experienced at least one syphilis episode in the past. This significant rate of syphilis diagnosis aligns with findings from other recent studies [25][26][27]. This trend may be attributed to an increased proportion of individuals engaging in unprotected sex due to reduced concerns about STIs, including HIV infection [18,20].…”

Sífilis adquirida: uma investigação epidemiológica

“…Atualmente os homens são os mais atingidos com essa patologia, mesmo com as constantes campanhas, medidas de controle e prevenção os números de casos anuais são crescentes, essas ocorrências propõem que novas estratégias governamentais sejam traçadas de forma efetiva para esse público. A expressividade dos casos confirmados de sífilis adquirida aponta para outra problemática devido ao modo de transmissão da doença que remete a outras afecções de natureza igual considerando a transmissão majoritária através do contato sexual (Godoy et al, 2020;Girma & Amogne, 2022).…”

Sensitivity and specificity of a syphilis rapid diagnostic test in blood donors’ samples

“…In addition, results were not stratified by syphilis stages, which likely influence the overall performance of RDT. 6 Few studies have addressed the accuracy of syphilis RDT among people living with HIV; 7 this is a relevant issue since previous studies suggest higher risk of false-positive syphilis reactivity in this population using different diagnostic tools. 8 …”