title: Otosyphilis in HIV-coinfected individuals: a case series from Toronto, Canada.
abstract: We sought to identify and review the clinical features and treatment outcomes of eight recent cases of otosyphilis in HIV-positive patients seen in Toronto. All patients reported tinnitus, and seven (87.5%) reported subjective hearing loss. Not taking auditory findings into consideration, four patients would be classified as having secondary syphilis, three patients as having early latent syphilis, and one patient as having latent syphilis of unknown duration. The median CD4 cell count was 370 x 10(6)/L. All patients were treated with intravenous aqueous penicillin G with regimens recommended for the treatment of neurosyphilis; four patients received adjunctive steroids. All eight patients experienced improvement in tinnitus and four of the seven (57.1%) patients with symptomatic hearing loss also experienced improvement. Otosyphilis can occur in HIV-positive individuals despite high CD4 cell counts, and is potentially reversible. Increased awareness of uncommon manifestations of syphilis in high-risk individuals is warranted to prompt appropriate investigation and treatment.
authors.affiliation: Division of Infectious Diseases, University Health Network, Toronto, Canada., Department of Medicine, University of Toronto, Canada. sharmistha.mishra@utoronto.ca
authors.forename: Sharmistha
authors.initials: S
authors.lastname: Mishra
authors.forename: Sharon Lynn
authors.initials: SL
authors.lastname: Walmsley
authors.forename: Mona Rafik
authors.initials: MR
authors.lastname: Loutfy
authors.forename: Rupert
authors.initials: R
authors.lastname: Kaul
authors.forename: Kenneth John
authors.initials: KJ
authors.lastname: Logue
authors.forename: Wayne Lawrence
authors.initials: WL
authors.lastname: Gold
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004427:Ear Diseases / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D034381:Hearing Loss / Q000145:classification / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D009864:Ontario; D010401:Penicillin G Benzathine / Q000627:therapeutic use; D013587:Syphilis / Q000145:classification / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome; D014505:Urban Population
chemical_list: D000900:Anti-Bacterial Agents; D010401:Penicillin G Benzathine