Seronegative Secondary Syphilis in 2 Patients Coinfected With Human Immunodeficiency Virus

Kingston, Adean A.; Vujevich, Justin; Shapiro, Michael; Hivnor, Chad; Jukic, D.M.; Junkins‐Hopkins, Jacqueline M.; Jih, Debra M.; Kostman, Jay R.; James, William D.

doi:10.1001/archderm.141.4.431

Cited by 43 publications

(24 citation statements)

References 10 publications

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“…Furthermore, there have been reports of false negative serological tests in HIV-infected individuals secondary to immune dysregulation. 29-31 It is significant to note that of our six infants with symptomatic syphilitic disease, two died shortly after birth.…”

Section: Discussionmentioning

confidence: 97%

Syphilis in HIV-infected Mothers and Infants

Yeganeh

Watts

Camarca

et al. 2015

Pediatric Infectious Disease Journal

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Background Untreated syphilis during pregnancy is associated with spontaneous abortion, stillbirth, prematurity and infant mortality. Syphilis may facilitate HIV transmission, which is especially concerning in low and middle income countries where both diseases are common. Methods We performed an analysis of data available from NICHD/HPTN 040 (P1043), a study focused on the prevention of intrapartum HIV transmission to 1684 infants born to 1664 untreated HIV-infected women. The present analysis evaluates risk factors and outcomes associated with a syphilis diagnosis in this cohort of HIV-infected women and their infants. Results Approximately 10% (n=171) of women enrolled had serological evidence of syphilis without adequate treatment documented and 1.4% (n=24) infants were dually HIV and syphilis infected. Multivariate logistic analysis showed that compared to HIV-infected women, co-infected women were significantly more likely to self-identify as non-white (AOR 2.5, 95% CI 1.5-4.2), to consume alcohol during pregnancy (AOR 1.5, 95% CI 1.1-2.1) and to transmit HIV to their infants (AOR 2.1, 95% CI 1.3-3.4), with 88% of HIV infections being acquired in-utero. As compared to HIV infected or HIV exposed infants, co-infected infants were significantly more likely to be born to mothers with VDRL titers ≥1:16 (AOR 3, 95% CI 1.1-8.2) and higher viral loads (AOR 1.5 95% CI 1.1-1.9). Of 6 newborns with symptomatic syphilis, 2 expired shortly after birth, and 2 were HIV-infected. Conclusion Syphilis continues to be a common co-infection in HIV-infected women and can facilitate in utero transmission of HIV to infants. Most infants are asymptomatic at birth, but those with symptoms have high mortality rates.

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Section: Discussionmentioning

confidence: 97%

Syphilis in HIV-infected Mothers and Infants

Yeganeh

Watts

Camarca

et al. 2015

Pediatric Infectious Disease Journal

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“…In general, infectious syphilis is considered to be more likely when RPR titres are 1:32 or greater [1]. However, we used a more liberal cut-point for our definition of acute syphilis, a titre of 1:16, because serologic responses may be altered in HIV co-infected patients, and can include false-negative or delayed seropositivity [11,14]. We reviewed medical chart data from participating HIV clinics for information on syphilis stage, where available, for all participants who had at least one acute syphilis test in 2000–09.…”

Section: Methodsmentioning

confidence: 99%

Patterns of syphilis testing in a large cohort of HIV patients in Ontario, Canada, 2000–2009

et al. 2013

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BackgroundSince 2000, reported syphilis cases increased ten-fold in Canada, particularly among men who have sex with men (MSM) co-infected with HIV. We characterized temporal patterns of of syphilis testing in a large cohort of HIV patients in Ontario, Canada.MethodsWe analyzed data from a multi-site cohort of people in HIV care from 2000 to 2009. Data were obtained from medical charts, interviews and record linkage with the syphilis test database at the Public Health Ontario Laboratories. We estimated the proportion that had syphilis testing at least once per year and the period and annual prevalence of reactive tests.ResultsAmong 4232 participants, the annual proportion tested rose from 2.7% (95%CI 1.9, 3.5) in 2000 to 54.6% (95%CI 52.9, 56.3) in 2009. Testing was most common for participants who were men who have sex with men (MSM), aged <30, recently diagnosed with HIV, were antiretroviral treatment naive, had routine HIV lab testing at least twice in that year, or tested for syphilis in the preceding year. The proportion with at least one reactive test in 2000–09 was 21.0% (95%CI 19.4, 22.7) for MSM, 5.3% (95%CI 3.3, 7.4) for non-MSM males, and 2.6% (95%CI 1.2, 4.0) for women. Among MSM, the annual prevalence of reactive syphilis tests with high RPR titre (≥1:16) peaked at 3.8% in 2009.ConclusionsThe burden of syphilis co-infection rose considerably among HIV-positive MSM, such that by 2009, at least 1 in 5 men had laboratory evidence of current or past infection. Interventions may be needed to boost syphilis testing to achieve goals set by guidelines even in settings with universal health care.

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“…In retrospect, the chief confounder in the case was the false‐negative RPR test, as the discussant suspected early on. Although nontreponemal tests are generally accurate in individuals with HIV, delayed seropositivity and false‐negatives have been reported in this population 12. The false‐negative could have also been a result of the prozone phenomenon, an unusual event, occurring in fewer than 2% of cases of secondary syphilis and attributed to a mismatch between antibody and very high antigen level.…”

Section: Commentarymentioning

confidence: 85%