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Clinical manifestations of early syphilis by HIV status
and gender: Results of the syphilis and HIV study.
Sexually Transmitted Diseases 2001;28(3):158-165.
Rompalo AM, Joesoef MR, O’Donnell JA, Augenbraun M, Brady W,
Radolf JD, Johnson RE, Rolfs RT, for the Syphilis and HIV Study Group.
Abstract
BACKGROUND: Despite reports of unusual clinical presentations and therapeutic
responses among HIV-infected patients with syphilis, syphilis has not been
regarded as a serious opportunistic infection that predictably progresses
among most HIV-coinfected patients. GOAL: To define and describe differences
in the presentation and response to treatment of early syphilis among HIV-infected
and HIV-uninfected patients, to describe any differences by gender, and to
determine if clinical presentation of central nervous system involvement
predicted serologic failure. DESIGN: A prospective, multicenter, randomized,
controlled trial of enhanced versus standard therapy to compare the benefit
of enhanced therapy, the clinical importance of central nervous system involvement,
and the clinical manifestations of early syphilis infection among HIV-infected
and HIV-uninfected patients. RESULTS: The median number of ulcers was significantly
greater among HIV-infected and HIV-uninfected patients, as was the percent
of HIV-infected patients with multiple ulcers. Among patients diagnosed with
secondary syphilis, a higher percentage of HIV-infected patients presented
with genital ulcers [13/53 (25%)] than did HIV-uninfected patients [27/200
(14%)]. No differences between HIV-infected and HIV-uninfected patients were
detected for other secondary syphilis manifestations. Although women presented
more frequently with secondary syphilis than did men, no other gender differences
in clinical manifestations were noted. Neurologic complaints were reported
most frequently among patients with secondary syphilis [103/248 patients
(42%)] compared with patients with primary syphilis [32/136 (24%)] and early
latent syphilis [48/ 142, (34%)] (P < 0.05), but no differences in neurologic
complaints were apparent by HIV status or CSF abnormalities. No neurologic
complaints were significantly associated with serologic treatment failures
at 6 months. CONCLUSIONS: Overall, HIV infection had a small effect on the
clinical manifestations of primary and secondary syphilis. Compared with
HIV-uninfected patients, HIV-infected patients with primary syphilis tended
to present more frequently with multiple ulcers, and HIV-infected patients
with secondary syphilis presented with concomitant genitals ulcers more frequently.