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

Kenyon, Chris; Osbak, Kara; Apers, Ludwig

doi:10.1093/ofid/ofy096

Cited by 37 publications

(39 citation statements)

References 15 publications

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“…Our data is in agreement with previous ndings that timely treatment of syphilis is highly effective, even in co-infection patients [15]. Some previous studies have also evaluated the association of HIV status with serologic outcomes, after syphilis treatment, by comparing patients with and without HIV infection [16,17]. Unfortunately, the results of these particular studies are inconsistent, so it remains unclear whether HIV-infected individuals are less likely to achieve serologic clearance of syphilis.…”

Section: Cd4 Lymphocyte Count and Cd4/cd8 Ratiosupporting

confidence: 91%

Identification of the Window Period Concurrent Infection with Syphilis and HIV: A Longitudinal Case Study

Wang¹,

Shao²,

Hong³

et al. 2020

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Abstract BACKGROUND: Due to the low incidence of concurrent human immunodeficiency virus (HIV) and syphilis infection identified during the window period, little is known about the clinical manifestations, diagnosis, and treatment efficacy at very early stages.METHODS: One longitudinal study was conducted in a 42-year-old blood donor who was concurrently infected with syphilis and HIV. This blood donor was treated with a penicillin-based regimen and early antiretroviral therapy (ART). Immunological and NAT methods were comparatively analyzed.RESULTS: A regular male donor who had two occasions of high-risk sexual behaviors 41 and 35 days before donation(DBD) donated whole blood at the Shenzhen Blood Center. Antiretroviral therapy was initiated at the 28th day after donation (DAD), and syphilis treatment was received at the 49th DAD. Microbiological analysis using a 4th generation anti-HIV ELISA and CLIA indicated a positive signal at the 6th DAD. All NAT tests for HIV RNA were reactive except the minipool (MP) NAT of six pooled samples at 117th DAD. The HIV viral load declined more than 4-log in copies per milliliter over 3 months, until reaching non-detectable levels at 246th DAD. Nevertheless, HIV-1 DNA was still detectable at 403rd DAD. Among all methods utilized, anti-TP ELISA detected syphilis infection at the earliest time. Toluidine red unheated serum test (TRUST) was negative around the 80th DAD.CONCLUSION: Concurrent infection with Syphilis and HIV during window period did not significantly change the sensitivity of reagents in detection nor alter the therapeutic efficacy for the treatment of both pathogens.

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Section: Cd4 Lymphocyte Count and Cd4/cd8 Ratiosupporting

confidence: 91%

Identification of the Window Period Concurrent Infection with Syphilis and HIV: A Longitudinal Case Study

Wang¹,

Shao²,

Hong³

et al. 2020

Preprint

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“…A striking feature of the current epidemics of syphilis in high-income countries is the increasing proportion of cases of syphilis that are repeat episodes of syphilis [ 1 – 3 ]. These infections occur predominantly in men who have sex with men (MSM) with high rates of partner change [ 1 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Syphilis reinfection is associated with an attenuated immune profile in the same individual: a prospective observational cohort study

et al. 2018

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BackgroundAscertaining if the clinical and immunological response to repeat syphilis differs from that in initial syphilis may assist in designing optimal syphilis screening strategies and vaccine design.MethodsWe prospectively recruited 120 patients with a new diagnosis of (baseline) syphilis. During a 24-month follow-up period, 11 of these patients had a further diagnosis of (repeat) syphilis. We conducted a paired comparison of their plasma cyto-chemokines at baseline and repeat syphilis.ResultsComparing to their baseline infection, paired analyses of the 11 individuals with repeat infections during follow-up revealed that these reinfections had lower concentrations of Interferon (IFN)α (0.8 [Interquartile range (IQR) 0.8–0.8 vs. 12.2 [IQR 1.6–24.2], P = 0.004) and Chemokine (C-C motif) ligand (CCL) 4 (0.9 [IQR 0.9–12.2 vs. 17.5 [IQR 4.9–32.8], P = 0.022].ConclusionIn this small study of 11 individuals, repeat syphilis was found to present with an attenuated immune response. The relevance of these findings to the design of optimal syphilis screening programs is discussed.

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“…Our study also revealed potential pitfalls for the implementation of opt-out routinised syphilis testing paired with HIV viral loads. This approach seeks to overcome under-testing that may occur if men undergo testing based solely on provider-or self-assessment of risk (which may or may not be accurate (32), or based on symptoms (which may not be present (10,11). Yet for ethical reasons, procedures that recognise men's autonomy should be incorporated in the implementation of this intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, there are challenges to ensuring that those at ongoing risk have access to screening, particularly if testing decisions are based only on perceived risk by patients and clinicians, or signs and symptoms. Asymptomatic syphilis can occur, particularly among men living with HIV and among those who have previously had syphilis and are reinfected (10,11).…”

Section: Introductionmentioning

confidence: 99%

Patient Perspectives on the Implementation of Routinised Syphilis Screening With HIV Viral load Testing: Qualitative Process Evaluation of the Enhanced Syphilis Screening Among HIV-positive Men Trial

MacKinnon

Grewal²,

Tan³

et al. 2020

Preprint

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Background: Syphilis infections have been on the rise, affecting men living with HIV in urban centres disproportionately. Since individuals in HIV care undergo routine blood testing, HIV clinics provide practical opportunities to conduct regular and frequent syphilis testing. Following the implementation of a routine syphilis testing intervention in HIV outpatient clinics, we conducted a qualitative process evaluation of patient experiences to measure patient acceptability, barriers to implementation, and facilitators of successful uptake. Methods: Upon completion of the trial, which took place at four HIV outpatient clinics in Toronto and Ottawa, Canada, we recruited male patients attending these clinics from November 2017 to April 2018. Interviews were conducted on-site and were audio-recorded and transcribed verbatim. All participants provided written informed consent. Interview data were analyzed using grounded theory, assessing qualitative modulators of effective uptake of routinised syphilis testing. Results: A total of 21 male patients were interviewed. Overall, interviewees found the clinical intervention acceptable, endorsing the practice of routinising syphilis testing alongside regular viral load bloodwork. Some men preferred, based on their self-assessment of syphilis risk, to opt out of testing; we considered this as a potential barrier to uptake of population-wide routinised syphilis testing. Interviewees also identified multiple facilitators of successful uptake, including the de-stigmatising of STI testing as a consequence of the universal nature of routinised testing. Participants recommended a routinised syphilis screening intervention to give patients peace of mind surrounding their sexual health. Participants identified HIV care clinics as comfortable and efficient locations to offer testing. Conclusions: Overall, most men were in support of implementing routinised syphilis testing as part of standard HIV care. From the patient perspective, HIV care clinics are convenient places to be tested for syphilis, and the routine approach was viewed to have a de-stigmatisng effect on syphilis testing. Trial registration: ClinicalTrials.gov NCT02019043; registered December 23, 2013.Trial registration: ClinicalTrials.gov NCT02019043; registered December 23, 2013.

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

Cited by 37 publications

References 15 publications

Identification of the Window Period Concurrent Infection with Syphilis and HIV: A Longitudinal Case Study

Identification of the Window Period Concurrent Infection with Syphilis and HIV: A Longitudinal Case Study

Syphilis reinfection is associated with an attenuated immune profile in the same individual: a prospective observational cohort study

Patient Perspectives on the Implementation of Routinised Syphilis Screening With HIV Viral load Testing: Qualitative Process Evaluation of the Enhanced Syphilis Screening Among HIV-positive Men Trial

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