Clinical manifestations of early syphilis by HIV status and gender

Results of the syphilis and HIV study

Anne Marie Rompalo, M. Riduan Joesoef, Judith A. O'Donnell, Michael Augenbraun, William Brady, Justin D. Radolf, Robert Johnson, Robert T. Rolfs

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)158-165
Number of pages8
JournalSexually Transmitted Diseases
Volume28
Issue number3
StatePublished - 2001

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Syphilis
HIV
Ulcer
Nervous System
HIV Infections
Latent Syphilis
Central Nervous System
Opportunistic Infections
Therapeutics
Treatment Failure
Secondary syphilis

ASJC Scopus subject areas

  • Dermatology
  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)

Cite this

Rompalo, A. M., Joesoef, M. R., O'Donnell, J. A., Augenbraun, M., Brady, W., Radolf, J. D., ... Rolfs, R. T. (2001). Clinical manifestations of early syphilis by HIV status and gender: Results of the syphilis and HIV study. Sexually Transmitted Diseases, 28(3), 158-165.

Clinical manifestations of early syphilis by HIV status and gender : Results of the syphilis and HIV study. / Rompalo, Anne Marie; Joesoef, M. Riduan; O'Donnell, Judith A.; Augenbraun, Michael; Brady, William; Radolf, Justin D.; Johnson, Robert; Rolfs, Robert T.

In: Sexually Transmitted Diseases, Vol. 28, No. 3, 2001, p. 158-165.

Research output: Contribution to journalArticle

Rompalo, AM, Joesoef, MR, O'Donnell, JA, Augenbraun, M, Brady, W, Radolf, JD, Johnson, R & Rolfs, RT 2001, 'Clinical manifestations of early syphilis by HIV status and gender: Results of the syphilis and HIV study', Sexually Transmitted Diseases, vol. 28, no. 3, pp. 158-165.
Rompalo, Anne Marie ; Joesoef, M. Riduan ; O'Donnell, Judith A. ; Augenbraun, Michael ; Brady, William ; Radolf, Justin D. ; Johnson, Robert ; Rolfs, Robert T. / Clinical manifestations of early syphilis by HIV status and gender : Results of the syphilis and HIV study. In: Sexually Transmitted Diseases. 2001 ; Vol. 28, No. 3. pp. 158-165.
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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.",
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T1 - Clinical manifestations of early syphilis by HIV status and gender

T2 - Results of the syphilis and HIV study

AU - Rompalo, Anne Marie

AU - Joesoef, M. Riduan

AU - O'Donnell, Judith A.

AU - Augenbraun, Michael

AU - Brady, William

AU - Radolf, Justin D.

AU - Johnson, Robert

AU - Rolfs, Robert T.

PY - 2001

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N2 - 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.

AB - 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.

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