title: Syphilis and neurosyphilis in a human immunodeficiency virus type-1 seropositive population: evidence for frequent serologic relapse after therapy.
abstract: OBJECTIVE
  To describe clinical and treatment aspects of syphilis infection among patients seropositive for the human immunodeficiency virus (HIV).
  
  
  METHODS
  Results of serologic tests for syphilis, CD4+ T-lymphocyte counts, and clinical response to therapy were retrospectively monitored in 100 HIV-infected adults with syphilis from a tertiary-care military HIV program.
  
  
  RESULTS
  Of the 1,206 HIV-infected patients, 100 (8.3%) in the cohort had syphilis; 61 patients were treated for active syphilis. Serologic or clinical relapse eventually occurred in 10 of the 56 treated patients (17.9%) with follow-up available; 7 of the 10 who relapsed had previously received high-dose intravenous or procaine penicillin therapy. Relapse occurred more than 12 months after initial therapy in 6 of 10 patients (60%) who experienced relapse; 5 patients experienced multiple relapses. The mean CD4+ T-lymphocyte count was not predictive of relapse. Patients with reactive cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL) test titers (4 of 7 patients [57%]) or the rash of secondary syphilis (4 of 14 patients [29%]) were at highest risk of subsequent relapse or treatment failure when monitored for an average of 2 years.
  
  
  CONCLUSIONS
  Standard penicillin regimens, including high-dose intravenous penicillin, transiently lowered serum VDRL titers in nearly all cases, but were sometimes inadequate in preventing serologic and clinical relapse in patients infected with HIV type-1, especially among those with secondary syphilis and reactive CSF VDRL titers. Careful long-term follow-up is essential, and repeated courses of therapy may be needed for patients infected with HIV type-1 who have syphilis.
authors.affiliation: Department of Internal Medicine (Infectious Diseases Division), Naval Medical Center, San Diego, California, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Malone
authors.forename: M R
authors.initials: MR
authors.lastname: Wallace
authors.forename: B B
authors.initials: BB
authors.lastname: Hendrick
authors.forename: A
authors.initials: A
authors.lastname: LaRocco
authors.forename: E
authors.initials: E
authors.lastname: Tonon
authors.forename: S K
authors.initials: SK
authors.lastname: Brodine
authors.forename: W A
authors.initials: WA
authors.lastname: Bowler
authors.forename: B S
authors.initials: BS
authors.lastname: Lavin
authors.forename: R E
authors.initials: RE
authors.lastname: Hawkins
authors.forename: E C
authors.initials: EC
authors.lastname: Oldfield
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D016009:Chi-Square Distribution; D006801:Humans; D009494:Neurosyphilis / Q000188:drug therapy; D010406:Penicillins / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D013587:Syphilis / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D010406:Penicillins