Response to Therapy Following Retreatment of Serofast Early Syphilis Patients With Benzathine Penicillin

Seña, Arlene C.; Wolff, Mark; Behets, Frieda; Damme, Kathleen Van; Martín, David H.; Leone, Peter A.; McNeil, Linda M.; Hook, Edward W.

doi:10.1093/cid/cis918

Cited by 54 publications

(53 citation statements)

References 4 publications

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“…Prior to our study, there has been only one study which focused on the serological response to therapy following retreatment of serofast early syphilis cases with only one dose of benzathine penicillin. 11 Our results suggest that there is no obvious benefit of retreating serofast patients with latent syphilis, which will avoid costly overtreatment of serofast latent syphilis and save a lot of money, especially in the situation that syphilis has reached alarming rates in China. 2,3 Further, our findings provide another evidence for addressing the unresolved questions about the serofast state and its management.…”

Section: Discussionmentioning

confidence: 81%

No improvement in serological response among serofast latent patients retreated with benzathine penicillin

Ren

Wang²,

Zheng

et al. 2015

Int J STD AIDS

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Persistent non-treponemal titres after treatment are common among patients with latent syphilis. Although retreatment is often done in clinical practice, optimal management remains uncertain due to the paucity of data regarding serological response to retreatment and long-term outcomes. We compared the serological responses of serofast latent syphilis patients retreated with 7.2 million units of benzathine penicillin with the responses of patients who did not receive retreatment (control group). We retrospectively analysed the serological response to therapy following retreatment of 35 serofast latent syphilis patients at 12 months with benzathine penicillin 2.4 million units weekly for 3 weeks. In all, 74.3% (26/35) of the cases with latent syphilis who failed to achieve serological cure at 12 months after initial therapy achieved serological cure after retreatment and after an additional 12 months of follow-up. However, statistically similar serological cure rate was observed in 80.0% (28/35) of the control group (p > .05). Our findings illustrate no improvement in serological response among serofast latent patients retreated with three doses of benzathine penicillin.

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Section: Discussionmentioning

confidence: 81%

No improvement in serological response among serofast latent patients retreated with benzathine penicillin

Ren

Wang²,

Zheng

et al. 2015

Int J STD AIDS

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“…One study tried to address this issue. Sena et al demonstrated that additional therapy with 2.4 million units of BPG for 82 HIVuninfected persons who remained serofast (ie, their rapid plasma reagin [RPR] titers had not declined 4-fold) 6 months after therapy with either 2.4 million units intramuscular BPG or 2 g of oral azithromycin for early syphilis resulted in a 27% serological response 6 months after retreatment [28]. No data on CSF examination and no long-term clinical data were available.…”

Section: Discussionmentioning

confidence: 99%

Management of Adult Syphilis: Key Questions to Inform the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines: Table 1.

Ghanem¹

2015

Clin Infect Dis.

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A panel of experts generated 8 "key questions" in the management of adult syphilis. A systematic literature review was conducted and tables of evidence were constructed to answer these important questions. Penicillin is the drug of choice to treat syphilis. Doxycycline to treat early and late latent syphilis is an acceptable alternate option if penicillin cannot be used. There is no added benefit to enhanced antimicrobial therapy when treating human immunodeficiency virus-infected persons with syphilis. If a patient misses a dose of penicillin in a course of weekly therapy for late syphilis, clinical experience suggests that an interval of 10-14 days between doses might be acceptable before restarting the sequence of injections. Pharmacologic considerations suggest that an interval of 7-9 days between doses, if feasible, may be more optimal. Missed doses are not acceptable for pregnant women. A cerebrospinal fluid examination to diagnose neurosyphilis is recommended in persons diagnosed with tertiary syphilis (eg, cardiovascular syphilis or late benign syphilis), persons with neurological signs or symptoms consistent with neurosyphilis, and asymptomatic persons whose serological titers do not decline appropriately following recommended therapy and in whom reinfection is ruled out. Infection and reinfection rates, particularly among men who have sex with men, are high. Frequent serological screening of this population appears to be the most cost-efficient intervention. The Centers for Disease Control and Prevention continues to recommend the use of the traditional rapid plasma reagin-based screening algorithm. The positive predictive value for syphilis associated with an isolated unconfirmed reactive treponemal chemiluminescence assay or enzyme immunoassay is low if the epidemiological risk and clinical probability for syphilis are low. Among pregnant women with serodiscordant serologies ( positive treponemal tests and a negative nontreponemal test), the risk of vertical transmission from mother to infant is low. Several important questions regarding the management of syphilis remain unanswered and should be a priority for future research.

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“…In the same study, all patients who were serofast were retreated with benzathine penicillin at 6 months per protocol. A secondary analysis of these retreated patients revealed that only an additional 27% of patients went on to meet criteria for serologic cure [33]. These data provide some guidance regarding which patients may be more likely to remain serofast, as well as demonstrate that retreatment rarely changes serologic response.…”

Section: Monitoring Response To Early Syphilis Therapymentioning

confidence: 84%

Clinical management of early syphilis

Holman¹,

Hook

2013

Expert Review of Anti-infective Therapy

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Early syphilis therapy was a focus of intense research in the early 20th century with many and varied approaches being used. The development of penicillin and its efficacy in the treatment of syphilis transformed syphilis management for many with and at risk for infection. However, problems such as beta-lactam allergies and the desire for easily administered, alternate therapies have led to evaluation of multiple other drugs, with doxycycline currently recommended as the main alternative. Ceftriaxone and azithromycin have been shown to be effective, however, each has its own difficulties. Follow-up relies on serological testing, leading to concerns when these tests do not decline appropriately. Given concerns about the potential for increased risk for treatment failure, patients with HIV and pregnant women are of particular concern.

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Response to Therapy Following Retreatment of Serofast Early Syphilis Patients With Benzathine Penicillin

Cited by 54 publications

References 4 publications

No improvement in serological response among serofast latent patients retreated with benzathine penicillin

No improvement in serological response among serofast latent patients retreated with benzathine penicillin

Management of Adult Syphilis: Key Questions to Inform the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines: Table 1.

Clinical management of early syphilis

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