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. 1996 Jun;72(3):176–181. doi: 10.1136/sti.72.3.176

Active syphilis in HIV infection: a multicentre retrospective survey. The German AIDS Study Group (GASG).

H Schöfer 1, M Imhof 1, E Thoma-Greber 1, N H Brockmeyer 1, M Hartmann 1, G Gerken 1, H W Pees 1, H Rasokat 1, H Hartmann 1, I Sadri 1, C Emminger 1, H J Stellbrink 1, R Baumgarten 1, A Plettenberg 1
PMCID: PMC1195645  PMID: 8707318

Abstract

OBJECTIVE: To study syphilis in HIV infection focusing on immunocompromised patients with an atypical or aggressive clinical course of syphilis, inappropriate serological reactions or an unreliable response to therapy. STUDY DESIGN: A multicentre retrospective chart review using a standardised questionnaire for all patients with active syphilis. SETTINGS: Thirteen dermatological and medical centres throughout Germany, all members of the German AIDS Study Group (GASG). PATIENTS: Clinical data of 11,368 HIV infected patients have been analysed for cases of active syphilis requiring treatment. Asymptotic patients with reactive serological parameters indicating latent syphilis without a need for treatment were excluded. RESULTS: Active syphilis was reported in 151 of 11,368 HIV infected patients (1.33%, range per centre 0.3%-5.1%). Most of the 151 syphilis patients were male (93%) and belonged to the homosexual or bisexual exposure category for HIV infection (79%); another 6% were iv drug users. Among the 151 syphilis patients primary syphilis was diagnosed in 17.2%, maculopapular secondary syphilis in 29.1%, ulcerating secondary syphilis in 7.3%, neurosyphilis in 16.6% and latent seropositive syphilis without clinical symptoms but serological abnormalities indicating active syphilis in 25.2%. A history of prior treatments for syphilis was reported in 50%. At the time of syphilis diagnosis 26.5% of the patients were in CDC stage II, 33.8% in stage III and 24.5% in stage IV of HIV disease (CDC classification 1987). CD4 cell count was lowest in those with ulcerating secondary syphilis (mean 307, SD 140/microliters) and neurosyphilis (351, SD 235/ microliters). The highest CD4 count was found in patients with early primary and early secondary syphilis (444, SD 163/microliters and 470, SD 355/microliters). Inappropriate serological response to syphilis infection was found in 81 of 151 patients (54%). Remarkable findings were false negative VDRL titres (11 patients with non primary syphilis), false negative TPHA (1) or 19S-IgM-FTA-ABS-tests (16), and strongly reactive VDRL (> or = 512, 8) or TPHA titres (> or = 10 240, 47). Treatment failures were reported in at least 6 of 151 cases (4%). CONCLUSIONS: Atypical clinical and serological courses of syphilis were observed in HIV infected patients. Ulcerating secondary syphilis with general symptoms ("malignant syphilis") was 60 times more frequent than in historic syphilis series. Neurosyphilis was found in one sixth of those with active syphilis. Therefore lumbar puncture should be considered a routine in coinfections with HIV and syphilis. Treatment efficacy should be monitored carefully.

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Selected References

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  1. Baker-Zander S. A., Hook E. W., 3rd, Bonin P., Handsfield H. H., Lukehart S. A. Antigens of Treponema pallidum recognized by IgG and IgM antibodies during syphilis in humans. J Infect Dis. 1985 Feb;151(2):264–272. doi: 10.1093/infdis/151.2.264. [DOI] [PubMed] [Google Scholar]
  2. Berry C. D., Hooton T. M., Collier A. C., Lukehart S. A. Neurologic relapse after benzathine penicillin therapy for secondary syphilis in a patient with HIV infection. N Engl J Med. 1987 Jun 18;316(25):1587–1589. doi: 10.1056/NEJM198706183162507. [DOI] [PubMed] [Google Scholar]
  3. Fennema J. S., van Ameijden E. J., Coutinho R. A., van Doornum G. J., Henquet C. J., van den Hoek J. A. HIV prevalence among clients attending a sexually transmitted diseases clinic in Amsterdam: the potential risk for heterosexual transmission. Genitourin Med. 1993 Feb;69(1):23–28. doi: 10.1136/sti.69.1.23. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Gordon S. M., Eaton M. E., George R., Larsen S., Lukehart S. A., Kuypers J., Marra C. M., Thompson S. The response of symptomatic neurosyphilis to high-dose intravenous penicillin G in patients with human immunodeficiency virus infection. N Engl J Med. 1994 Dec 1;331(22):1469–1473. doi: 10.1056/NEJM199412013312201. [DOI] [PubMed] [Google Scholar]
  5. Gourevitch M. N., Selwyn P. A., Davenny K., Buono D., Schoenbaum E. E., Klein R. S., Friedland G. H. Effects of HIV infection on the serologic manifestations and response to treatment of syphilis in intravenous drug users. Ann Intern Med. 1993 Mar 1;118(5):350–355. doi: 10.7326/0003-4819-118-5-199303010-00005. [DOI] [PubMed] [Google Scholar]
  6. Gregory N., Sanchez M., Buchness M. R. The spectrum of syphilis in patients with human immunodeficiency virus infection. J Am Acad Dermatol. 1990 Jun;22(6 Pt 1):1061–1067. doi: 10.1016/0190-9622(90)70153-9. [DOI] [PubMed] [Google Scholar]
  7. Hay P. E., Clarke J. R., Taylor-Robinson D., Goldmeier D. Detection of treponemal DNA in the CSF of patients with syphilis and HIV infection using the polymerase chain reaction. Genitourin Med. 1990 Dec;66(6):428–432. doi: 10.1136/sti.66.6.428. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Held J. L., Grossman M. E. Syphilis associated with human immunodeficiency virus infection. J Am Acad Dermatol. 1989 Feb;20(2 Pt 1):295–295. doi: 10.1016/s0190-9622(89)80064-7. [DOI] [PubMed] [Google Scholar]
  9. Hicks C. B. Syphilis and HIV infection. Dermatol Clin. 1991 Jul;9(3):493–501. [PubMed] [Google Scholar]
  10. Ijsselmuiden O. E., van der Sluis J. J., Mulder A., Stolz E., Bolton K. P., van Eijk R. V. An IgM capture enzyme linked immunosorbent assay to detect IgM antibodies to treponemes in patients with syphilis. Genitourin Med. 1989 Apr;65(2):79–83. doi: 10.1136/sti.65.2.79. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Johns D. R., Tierney M., Felsenstein D. Alteration in the natural history of neurosyphilis by concurrent infection with the human immunodeficiency virus. N Engl J Med. 1987 Jun 18;316(25):1569–1572. doi: 10.1056/NEJM198706183162503. [DOI] [PubMed] [Google Scholar]
  12. Jurado R. L., Campbell J., Martin P. D. Prozone phenomenon in secondary syphilis. Has its time arrived? Arch Intern Med. 1993 Nov 8;153(21):2496–2498. [PubMed] [Google Scholar]
  13. Katz D. A., Berger J. R., Duncan R. C. Neurosyphilis. A comparative study of the effects of infection with human immunodeficiency virus. Arch Neurol. 1993 Mar;50(3):243–249. doi: 10.1001/archneur.1993.00540030009006. [DOI] [PubMed] [Google Scholar]
  14. Lefevre J. C., Bertrand M. A., Bauriaud R. Evaluation of the Captia enzyme immunoassays for detection of immunoglobulins G and M to Treponema pallidum in syphilis. J Clin Microbiol. 1990 Aug;28(8):1704–1707. doi: 10.1128/jcm.28.8.1704-1707.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Lukehart S. A., Hook E. W., 3rd, Baker-Zander S. A., Collier A. C., Critchlow C. W., Handsfield H. H. Invasion of the central nervous system by Treponema pallidum: implications for diagnosis and treatment. Ann Intern Med. 1988 Dec 1;109(11):855–862. doi: 10.7326/0003-4819-109-11-855. [DOI] [PubMed] [Google Scholar]
  16. Musher D. M., Hamill R. J., Baughn R. E. Effect of human immunodeficiency virus (HIV) infection on the course of syphilis and on the response to treatment. Ann Intern Med. 1990 Dec 1;113(11):872–881. doi: 10.7326/0003-4819-113-11-872. [DOI] [PubMed] [Google Scholar]
  17. Pereira L. H., Embil J. A., Haase D. A., Manley K. M. Prevalence of human immunodeficiency virus in the patient population of a sexually transmitted disease clinic. Association with syphilis and gonorrhea. Sex Transm Dis. 1992 Mar-Apr;19(2):115–120. [PubMed] [Google Scholar]
  18. Plettenberg A., Bahlmann W., Stoehr A., Meigel W. Klinische und serologische Befunde der Lues bei HIV-infizierten Patienten. Dtsch Med Wochenschr. 1991 Jun 21;116(25):968–972. doi: 10.1055/s-2008-1063704. [DOI] [PubMed] [Google Scholar]
  19. Quinn T. C., Groseclose S. L., Spence M., Provost V., Hook E. W., 3rd Evolution of the human immunodeficiency virus epidemic among patients attending sexually transmitted disease clinics: a decade of experience. J Infect Dis. 1992 Mar;165(3):541–544. doi: 10.1093/infdis/165.3.541. [DOI] [PubMed] [Google Scholar]
  20. Schmidt B. L., Luger A., Duschet P., Seifert W., Gschnait F. Spezifische IgM-Teste in der Syphilis-Diagnose. Hautarzt. 1994 Oct;45(10):685–689. doi: 10.1007/s001050050150. [DOI] [PubMed] [Google Scholar]
  21. Taniguchi S., Osato K., Hamada T. The prozone phenomenon in secondary syphilis. Acta Derm Venereol. 1995 Mar;75(2):153–154. doi: 10.2340/0001555575153154. [DOI] [PubMed] [Google Scholar]
  22. Young H. Syphilis: new diagnostic directions. Int J STD AIDS. 1992 Nov-Dec;3(6):391–413. doi: 10.1177/095646249200300601. [DOI] [PubMed] [Google Scholar]

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