Otosyphilis in HIV-coinfected individuals: a case series from Toronto, Canada.
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.
Mishra
Sharmistha
S
Division of Infectious Diseases, University Health Network, Toronto, Canada., Department of Medicine, University of Toronto, Canada. sharmistha.mishra@utoronto.ca
Walmsley
Sharon Lynn
SL
Loutfy
Mona Rafik
MR
Kaul
Rupert
R
Logue
Kenneth John
KJ
Gold
Wayne Lawrence
WL
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
D000900:Anti-Bacterial Agents; D010401:Penicillin G Benzathine