Effectiveness of syphilis treatment using azithromycin and/or benzathine penicillin in Rakai, Uganda.
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.
Kiddugavu
Mohammed G
MG
Rakai Health Science Program, Uganda Virus Research Institute, Entebbe, Uganda.
Kiwanuka
Noah
N
Wawer
Maria J
MJ
Serwadda
David
D
Sewankambo
Nelson K
NK
Wabwire-Mangen
Fred
F
Makumbi
Fredrick
F
Li
Xianbin
X
Reynolds
Steven J
SJ
Quinn
Thomas C
TC
Gray
Ronald H
RH
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
D000900:Anti-Bacterial Agents; D017963:Azithromycin; D010401:Penicillin G Benzathine