title: Effectiveness of syphilis treatment using azithromycin and/or benzathine penicillin in Rakai, Uganda.
abstract: OBJECTIVE
  The goal of this study was to assess azithromycin and/or benzathine penicillin for treatment of syphilis.
  
  
  METHODS
  In a population-based study, participants with serologic syphilis (TRUST with TPHA confirmation) were offered 2.4 MU benzathine penicillin intramuscularly. Intervention arm participants received 1 g presumptive oral azithromycin. We assessed cure rates with penicillin or azithromycin given alone and in combination. Cure assessed after 10 months was defined as seroreversion or a 4-fold decrease in titer. The rate ratio (RR) of cure and 95% confidence intervals (95% CIs) were estimated by log binomial regression.
  
  
  RESULTS
  Among 952 cases with syphilis, 18% received penicillin alone, 17% azithromycin only, and 65% dual treatment. The overall cure rate was 61%. Cure rates were lower in males compared with females (RR, 0.89; 95% CI, 0.80-0.99) and in subjects with initial titers > or =1:4 compared with < or =1:2 (RR, 0.77; 95% CI, 0.69-0.86). There was no significant differences in cure rates among HIV-positive and HIV-negative persons. With initial titers < or =1:2, there were no differences in cure rates by treatment regimen. However, with initial titers > or =1:4, significantly higher cure rates were observed with azithromycin alone (adjusted RR, 1.38; 95% CI, 0.97-1.96), and with dual treatment of azithromycin and benzathine penicillin (RR, 1.38; 95% CI, 1.03-1.87) compared with penicillin alone.
  
  
  CONCLUSIONS
  Azithromycin alone or in combination with penicillin achieved higher cure rates than penicillin alone in cases with a high initial TRUST titer. In low-titer infections, the 3 drug combinations were equally effective. HIV status did not affect cure rates.
authors.affiliation: Rakai Health Science Program, Uganda Virus Research Institute, Entebbe, Uganda.
authors.forename: Mohammed G
authors.initials: MG
authors.lastname: Kiddugavu
authors.forename: Noah
authors.initials: N
authors.lastname: Kiwanuka
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Nelson K
authors.initials: NK
authors.lastname: Sewankambo
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: Fredrick
authors.initials: F
authors.lastname: Makumbi
authors.forename: Xianbin
authors.initials: X
authors.lastname: Li
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017963:Azithromycin / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D010401:Penicillin G Benzathine / Q000008:administration & dosage*; D012423:Rural Health; D013587:Syphilis / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin; D010401:Penicillin G Benzathine