A single dose of benzathine penicillin G is as effective as multiple doses of benzathine penicillin G for the treatment of HIV-infected persons with early syphilis - PubMed (original) (raw)

. 2015 Feb 15;60(4):653-60.

doi: 10.1093/cid/ciu888. Epub 2014 Nov 10.

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A single dose of benzathine penicillin G is as effective as multiple doses of benzathine penicillin G for the treatment of HIV-infected persons with early syphilis

Anuradha Ganesan et al. Clin Infect Dis. 2015.

Abstract

Background: Treatment guidelines recommend the use of a single dose of benzathine penicillin G (BPG) for treating early syphilis in human immunodeficiency virus (HIV)-infected persons. However, data supporting this recommendation are limited. We examined the efficacy of single-dose BPG in the US Military HIV Natural History Study.

Methods: Subjects were included if they met serologic criteria for syphilis (ie, a positive nontreponemal test [NTr] confirmed by treponemal testing). Response to treatment was assessed at 13 months and was defined by a ≥4-fold decline in NTr titer. Multivariate Cox proportional hazard regression models were utilized to examine factors associated with treatment response.

Results: Three hundred fifty subjects (99% male) contributed 478 cases. Three hundred ninety-three cases were treated exclusively with BPG (141 with 1 dose of BPG). Treatment response was the same among those receiving 1 or >1 dose of BPG (92%). In a multivariate analysis, older age (hazard ratio [HR], 0.82 per 10-year increase; 95% confidence interval [CI], .73-.93) was associated with delayed response to treatment. Higher pretreatment titers (reference NTr titer <1:64; HR, 1.94 [95% CI, 1.58-2.39]) and CD4 counts (HR, 1.07 for every 100-cell increase [95% CI, 1.01-1.12]) were associated with a faster response to treatment. Response was not affected by the number of BPG doses received (reference, 1 dose of BPG; HR, 1.11 [95% CI, .89-1.4]).

Conclusions: In this cohort, additional BPG doses did not affect treatment response. Our data support the current recommendations for the use of a single dose of BPG to treat HIV-infected persons with early syphilis.

Keywords: HIV-infected persons; benzathine penicillin G; early syphilis; treatment response.

© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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Figures

Figure 1.

Figure 1.

Graphical representation of the cases selected for this analysis. Although subjects could contribute >1 case to this analysis, subsequent cases were not included if treatment was not recorded for the preceding case. For this figure, response was assessed at 13 months following treatment.

Figure 2.

Figure 2.

Kaplan–Meier curves, comparing time to serologic response in early syphilis cases treated with different therapeutic regimens. Abbreviation: BPG, benzathine penicillin G.

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References

    1. Workowski KA, Berman S. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1–110. -PubMed
    1. Dowell D, Polgreen PM, Beekmann SE, Workowski KA, Berman SM, Peterman TA. Dilemmas in the management of syphilis: a survey of infectious diseases experts. Clin Infect Dis. 2009;49:1526–9. -PubMed
    1. Lukehart SA, Hook EW, 3rd, Baker-Zander SA, Collier AC, Critchlow CW, Handsfield HH. Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment. Ann Intern Med. 1988;109:855–62. -PubMed
    1. Holtom PD, Larsen RA, Leal ME, Leedom JM. Prevalence of neurosyphilis in human immunodeficiency virus-infected patients with latent syphilis. Am J Med. 1992;93:9–12. -PubMed
    1. van der Valk PG, Kraai EJ, van Voorst Vader PC, Haaxma-Reiche H, Snijder JA. Penicillin concentrations in cerebrospinal fluid (CSF) during repository treatment regimen for syphilis. Genitourin Med. 1988;64:223–5. -PMC -PubMed

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