A pilot study evaluating ceftriaxone and penicillin G as treatment agents for neurosyphilis in human immunodeficiency virus-infected individuals.
To compare intravenous (iv) ceftriaxone and penicillin G as therapy for neurosyphilis, blood and CSF were collected before and 14-26 weeks after therapy from 30 subjects infected with human immunodeficiency virus (HIV)-1 who had (1) rapid plasma reagin (RPR) test titers >/=1&rcolon;16, (2) reactive serum treponemal tests, and (3) either reactive CSF-Venereal Disease Research Laboratory (VDRL) tests or CSF abnormalities: (a) CSF WBC values >/=20/microL or (b) CSF protein values >/=50 mg/dL. At baseline, more ceftriaxone recipients had skin symptoms and signs (6 [43%] of 14 vs. 1 [6%] of 16; P=.03), and more penicillin recipients had a history of neurosyphilis (7 [44%] of 16 vs. 1 [7%] of 14; P=.04). There was no difference in the proportion of subjects in each group whose CSF measures improved. Significantly more ceftriaxone recipients had a decline in serum RPR titers (8 [80%] of 10 vs. 2 [13%] of 15; P=. 003), even after controlling for baseline RPR titer, skin symptoms and signs, or prior neurosyphilis were controlled for. Differences in the 2 groups limit comparisons between them. However, iv ceftriaxone may be an alternative to penicillin for treatment of HIV-infected patients with neurosyphilis and concomitant early syphilis.
Marra
C M
CM
Departments of Neurology and Medicine, Division of Infectious Diseases, University of Washington, Seattle, WA, USA. cmarra@u. washington.edu
Boutin
P
P
McArthur
J C
JC
Hurwitz
S
S
Simpson
P A
PA
Haslett
J A
JA
van der Horst
C
C
Nevin
T
T
Hook
E W
EW
D000328:Adult; D002443:Ceftriaxone / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009494:Neurosyphilis / Q000188:drug therapy* / Q000382:microbiology; D010400:Penicillin G / Q000627:therapeutic use*; D010406:Penicillins / Q000627:therapeutic use*; D010865:Pilot Projects
D002511:Cephalosporins; D010406:Penicillins; D002443:Ceftriaxone; D010400:Penicillin G