Serological Response to Treatment of Syphilis with Doxycycline Compared with Penicillin in HIV-Infected Individuals

Abstract

Serological response to treatment of syphilis with orally administered doxycycline or intramuscularly administered penicillin was assessed in patients with concurrent HIV. All HIV-infected individuals diagnosed with syphilis attending 3 hospitals in Copenhagen, Denmark were included. Odds ratios (ORs) with 95% confidence intervals (CI) associated with serological outcome were modelled using propensity-score-adjusted logistic regression analysis. In total, 202 cases were treated with doxycycline or intramuscular penicillin. At 12 months, serological failure was observed in 12 cases (15%) treated with doxycycline and in 8 cases (17%) treated with penicillin (OR 0.78 (95% CI 0.16-3.88), p = 0.76). The serological cure rate at 12 months was highest in patients with primary syphilis (100%), followed by patients with secondary (89%), early latent (71%) and late latent (67%) syphilis (p = 0.006). In conclusion, this study provides evidence for the use of doxycycline as a treatment option when treating a HIV-infected population for syphilis.

2020 European guideline on the management of syphilis

“…Non‐penicillin antibiotics have been evaluated. These include tetracyclines (doxycycline is the preferred tetracycline with good penetration into the CSF) and macrolides, taken orally 99–103 . Doxycycline has been evaluated more than any other non‐penicillin antibiotics but all studies have been observational and retrospective 100–103 .…”

“…These include tetracyclines (doxycycline is the preferred tetracycline with good penetration into the CSF) and macrolides, taken orally 99–103 . Doxycycline has been evaluated more than any other non‐penicillin antibiotics but all studies have been observational and retrospective 100–103 . Newer anti‐treponemal antibiotics include the intramuscular or intravenous extended‐spectrum cephalosporin (ESC) ceftriaxone 103–106 .…”

“…These patients should be tested again at 12 months. Patients with repeat early syphilis have usually higher titres and a slower decline in titres post‐treatment 101,151,152 ‐If a fourfold decrease in the antibody titre of a NTT does not occur after 6–12 months, (‘serological failure’) some professionals recommend additional treatment with one weekly injection of BPG 2.4 million units for 3 weeks but no robust evidence for this recommendation exists (2, D) ‐A negative NTT can be obtained in a substantial number of (but not in all) patients treated for early syphilis after 1–2 years.…”

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

“…Our study revealed that 81% achieved seroreversion after 12 months of treatment. One study indicated that nearly 70% of the latent syphilis cases with HIV coinfection achieved seroreversion [ 56 ]. Evaluating treatment effectiveness with the adequacy of serological responses showed a non-significant difference between BPG and DOXY, suggesting that DOXY can be used alternatively.…”

Terapi <i>Doxycycline </i>pada Laki-laki Homoseksual dengan Sifilis Sekunder dan Infeksi <i>Human Immunodeficiency Virus</i>

“…(2016) melakukan evaluasi klinis dan serologis pasien sifilis pada berbagai stadium dan menyimpulkan bahwa doxycycline dapat digunakan sebagai alternatif terapi yang efisien pada populasi dengan infeksi HIV. 12 Pada laporan kasus ini akan dibahas suatu kasus koinfeksi sifilis dan HIV pada seorang laki-laki homoseksual, dengan tujuan untuk memperdalam wawasan tentang penegakkan diagnosis dan manajemen terapi yang dapat diaplikasikan pada kasus serupa di poliklinik kulit dan kelamin RSUD Dr. Moewardi Surakarta.…”