Response of HIV-infected patients with asymptomatic syphilis to intensive intramuscular therapy with ceftriaxone or procaine penicillin.
Abstract
The objective of this prospective pilot study was to evaluate the response of HIV-infected patients with asymptomatic syphilis to one of two intensive antibiotic treatment regimens. Thirty-one HIV-infected patients with serum rapid plasma reagin titre > or =1:4 and no clinical findings of syphilis were randomized to receive daily intramuscular injections of ceftriaxone or procaine penicillin (plus oral probenecid) for 15 days; 24 returned for follow-up study. Seven of 10 (70%) procaine penicillin-treated patients and 10 of 14 (71%) ceftriaxone-treated patients had a > or =4-fold decline in RPR (P=0.94); two penicillin-treated and one ceftriaxone-treated patient relapsed. Two patients failed ceftriaxone therapy. Three penicillin-treated, and two ceftriaxone-treated patients were serofast. Serological responses were similar in those patients with and without asymptomatic neurosyphilis. There was no difference in the serologic response to daily treatment with ceftriaxone vs that with procaine penicillin plus probenecid; both treatments were associated with comparatively high rates of serological non-response and relapse.
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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 [630]
A single dose of 2.4 MU benzathine penicillin G in patients with asymptomatic neurosyphilis showed a CSF relapse rate of 21%, which was twice that of other penicillin preparations.
“A single dose of 2.4 MU benzathine penicillin G in patients with asymptomatic neurosyphilis showed a CSF relapse rate of 21% which was twice that of other penicillin preparations.90”
From BASHH UK guidelines for the management of syphilis 2024 (2024) · cites this paper as [90]
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Sexually Transmitted Infections Treatment Guidelines, 2021
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BASHH UK guidelines for the management of syphilis 2024
Kingston, M., Apea, V., Evans, C., Fifer, H., Foster, K., Patrick, P., Grant, A., Manns, V., Ramsden, S., Sinka, K., et al. (2024) · International Journal of STD & AIDS · doi:10.1177/09564624241280406 · Cited by 51 · see citing works
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- Authors
- Smith, N. H., Musher, D. M., Huang, D. B., Rodriguez, P. S., Dowell, M. E., Ace, W., & White, A. C.
- Affiliations
- Baylor College of Medicine (US)
- Venue
- International Journal of STD & AIDS
- Publisher
- SAGE Publications
- Published
- 2004-05
- Volume
- 15
- Issue
- 5
- Pages
- 328-332
- ISSN
- 0956-4624 (ISSN-L)
- 1758-1052
- OpenAlex
- W2093379777
- Cited by
- 74
- References
- 25
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 4 · 2015: 7 · 2014: 4 · 2013: 1
- FWCI
- 3.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of STD & AIDS (publishedVersion)
- PubMed (publishedVersion)
- PubMed
- Topics
- Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Historical Medical Research and Treatments
- Life Sciences › Immunology and Microbiology › Parasitology › Vector-borne infectious diseases
- Keywords
- asymptomatic syphilis, HIV infection, ceftriaxone, procaine penicillin, probenecid, intramuscular antibiotic therapy, neurosyphilis, treatment failure
- MeSH terms
- Adult, Anti-Bacterial Agents, Ceftriaxone, Female, Humans, Injections, Intramuscular, Male, Middle Aged, Penicillin G Procaine, Pilot Projects, Prospective Studies, Reagins, Recurrence, Syphilis, HIV Infections, Treatment Outcome
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