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Cited by 133Syphilis Diagnosis and TreatmentHistorical Medical Research and TreatmentsInfectious Diseases and Tuberculosis

Response of latent syphilis or neurosyphilis to ceftriaxone therapy in persons infected with human immunodeficiency virus.

Dowell, Mark E., Ross, Paul G., Musher, Daniel M., Cate, Thomas R., Baughn, Robert E.·1992·The American Journal of Medicine
DOI 10.1016/0002-9343(92)90574-u
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Abstract

Objective To evaluate the effect of ceftriaxone in treating latent syphilis or asymptomatic neurosyphilis in patients infected with the human immunodeficiency virus (HIV).Design Follow-up study of patients treated at two HIV-based clinics during 16 months from 1989 to 1991.Patients Patients were those in whom a clinical diagnosis of latent syphilis or asymptomatic neurosyphilis was made, who received all recommended doses of antimicrobial therapy, and who returned for follow-up visits for 6 or more months.Results Forty-three patients were treated with ceftriaxone, 1 to 2 g daily for 10 to 14 days. Thirteen underwent lumbar puncture before treatment; 7 (58%) had documented neurosyphilis (pleocytosis in 5, elevated protein levels in 6, VDRL reactive in cerebrospinal fluid [CSF] in 7), and 6 had documented latent syphilis (entirely normal CSF). The remaining 30 were said to have presumed latent syphilis. There was no relation between the diagnosis and the selected dosage of ceftriaxone. Response rates were similar in those who had documented neurosyphilis and documented or presumed latent syphilis. Overall, 28 patients (65%) responded to therapy, 5 (12%) were serofast, 9 (21%) had a serologic relapse, and 1 (2%) who experienced progression to symptomatic neurosyphilis was a therapeutic failure. Thirteen patients received benzathine penicillin for presumed latent syphilis; results were similar to those observed after ceftriaxone therapy, with 8 (62%) responders, 1 (8%) serofast, 2 (15%) relapses, and 2 (15%) failures. CD4 cell counts in responders were not different from those who failed to respond.Conclusions Even in the absence of neurologic symptoms, half of the HIV-infected persons who have serologic evidence of syphilis may have neurosyphilis. Although ceftriaxone achieves high serum and CSF levels, 10 to 14 days of treatment with this drug were associated with a 23% failure rate in HIV-infected patients who had latent syphilis or asymptomatic neurosyphilis. Three doses of benzathine penicillin did not have a significantly higher relapse rate and may provide appropriate therapy, at least for documented latent syphilis in persons co-infected with HIV. Studies comparing ceftriaxone with 10 to 14 doses of procaine penicillin are needed to determine the most cost-effective treatment for asymptomatic neurosyphilis or presumed latent syphilis in this group of patients.

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Crossref · 10.1016/0002-9343(92)90574-u

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  • Small observational studies conducted among persons with HIV and neurosyphilis report that ceftriaxone 1-2 g IV daily for 10-14 days might be effective as an alternative agent.

    “Small observational studies conducted among persons with HIV and neurosyphilis report that ceftriaxone 1–2 g IV daily for 10–14 days might be effective as an alternative agent (628–630).”

    From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [629]

  • Several different ceftriaxone regimens have been shown to be effective for the treatment of early syphilis.

    “Several different ceftriaxone regimens have been shown to be effective for the treatment of early syphilis.104–113”

    From BASHH UK guidelines for the management of syphilis 2024 (2024) · cites this paper as [110]

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Authors
Dowell, M. E., Ross, P. G., Musher, D. M., Cate, T. R., & Baughn, R. E.
Affiliations
  • United States Department of Veterans Affairs (US)
  • Harris Health System (US)
  • Baylor College of Medicine (US)
Corresponding author
Musher, Daniel M.
ORCID
Musher, Daniel M.
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
1992-11
Volume
93
Issue
5
Pages
481-488
ISSN
0002-9343 (ISSN-L)
DOI
10.1016/0002-9343(92)90574-u
OpenAlex
W2105769864
Cited by
133
References
56
Citations by year
2025: 2 · 2024: 4 · 2023: 1 · 2022: 4 · 2021: 7 · 2020: 3 · 2018: 2 · 2017: 4 · 2016: 1 · 2015: 10 · 2014: 8 · 2013: 3 · 2012: 1
FWCI
3.03
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The American Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Historical Medical Research and Treatments
  • Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
Keywords
ceftriaxone, latent syphilis, neurosyphilis, HIV infection, benzathine penicillin, treatment response, CD4 count, cerebrospinal fluid, syphilis screening, treatment failure, HIV-associated neurosyphilis, VDRL serology, lumbar puncture, treatment duration, benzathine
MeSH terms
Adult, Ceftriaxone, Female, Humans, Male, Neurosyphilis, Penicillin G Benzathine, Syphilis Serodiagnosis, Syphilis, Latent, HIV Infections, Treatment Outcome

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