Syphilis in the HIV-infected patient: An update on epidemiology, diagnosis, and management

Abstract

After a decade of unprecedented declines, incidence of early-stage syphilis in the United States and Europe has increased significantly since 2000. These cases have occurred at disproportionately elevated rates among people infected with HIV. Speculation continues as to whether the clinical spectrum of syphilis is qualitatively different among those individuals who are HIV infected. Recent data suggest that individuals who are immune compromised because of HIV have a higher likelihood of developing neurosyphilis. Recommendations for treatment of syphilis remain the same for patients with and without HIV.

Neurosyphilis in the mixed urban–rural community of the Netherlands

“…In some studies, HIV-positive patients are reported to not only have a higher incidence of early rather than late neurosyphilis, but also a shorter period before the manifestation of late forms of neurosyphilis (27,41,42). This may be explained by their compromised immune system.…”

Indicações da punção liquórica nos portadores de sífilis

“…2 A sífilis anal primária é doença comum dos praticantes do sexo anal receptivo. 3 É causada pelo espiroqueta Treponema pallidum e tem a úlcera, geralmente única, que surge no ânus ou no canal anal, duas a seis semanas após o contato, como primeira manifestação. Todavia, essas lesões têm morfologia variada e a suspeição deverá ser feita nos praticantes do sexo anal que tenham úl-ceras perianais.…”

“…E, quando as contagens séricas dos linfócitos T CD4+ forem inferiores a 200 céls/mm 3 , esse teste regulariza menos 3,7 vezes que naqueles que têm mais que 200 dessas células/mm 3 . 26 Doentes soropositivos para o HIV têm maior chance de desenvolver neurolues, 3,27 sendo importante afastar o diagnóstico em todos esses casos. 10 Entretanto, punção liquórica em todos os coinfectados HIV/sífilis é controversa.…”

Malignant syphilis in an HIV seropositive woman

“…Most reported cases of malignant syphilis are described in association with HIV infection. Patients co‐infected with syphilis and HIV are also at risk for developing neurosyphilis [1,3,4]. Penicillin remains the treatment of choice in all stages of syphilis.…”