Effectiveness of penicillin G benzathine therapy for primary and secondary syphilis in HIV infection

Malignant syphilis is a rare and severe variant of secondary syphilis. It is clinically characterized by large papular, nodular and ulcerative lesions affecting the trunk and the extremities and covered with thick crust. We present a case of 52-year-old homosexual male who developed malignant syphilis and this was the first clinical manifestation of HIV infection. The patient was treated successfully with intravenous aqueous crystalline penicillin G. Physicians should recognize malignant syphilis and considered it in all HIV-infected individuals with ulceronodular skin lesions.

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Clinical trial protocol to evaluate the efficacy of cefixime in the treatment of early syphilis

Trials ◽

10.1186/s13063-020-04885-z ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Shivani N. Mehta ◽

Chrysovalantis Stafylis ◽

David M. Tellalian ◽

Pamela L. Burian ◽

Cliff M. Okada ◽

...

Keyword(s):

Clinical Trial ◽

Los Angeles ◽

Hiv Infection ◽

Treatment Options ◽

Post Treatment ◽

Penicillin G ◽

Benzathine Penicillin ◽

Open Label ◽

Early Syphilis ◽

Recommended Treatment

Abstract Background Syphilis rates have been increasing both in the USA and internationally with incidence higher among men-who-have-sex-with-men and people living with human immunodeficiency virus (HIV) infection. Currently, benzathine penicillin is the recommended treatment for syphilis in all patients. Global shortages and cost increases in benzathine penicillin call for alternative treatment options. This study evaluates the efficacy of oral cefixime for the treatment of early syphilis. Methods We are conducting a randomized, multisite, open-label, non-comparative clinical trial in Los Angeles and Oakland, CA. Eligible participants are ≥ 18 years old, with primary, secondary, or early latent syphilis (rapid plasma reagin [RPR] titer ≥ 1:8). Patients with HIV infection must have a viral load ≤ 200 copies/mL and CD4+ T cell count ≥ 350 cells/μL during the past 6 months. Participants are randomized to receive either 2.4 M IU benzathine penicillin G intramuscularly once or cefixime 400 mg orally twice a day for 10 days. Participants return at 3, 6, and 12 months post-treatment for follow-up RPR serological testing. The primary outcome is the proportion of participants who achieve ≥ 4-fold RPR titer decrease at 3 or 6 months post-treatment. Discussion Clinical trials evaluating the efficacy of alternative antibiotics to penicillin are urgently needed. Trial registration Clinicaltrials.gov NCT03660488. Registered on 4 September 2018.

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Immune reconstitution inflammatory syndrome associated with secondary syphilis: dermatologic, neurologic and ophthalmologic compromise in an HIV patient

International Journal of STD & AIDS ◽

10.1177/0956462418813045 ◽

2019 ◽

Vol 30 (5) ◽

pp. 509-511

Author(s):

Sami Alcedo ◽

Renee Newby ◽

Juan José Montenegro ◽

Paola Rondan ◽

Jorge Arevalo ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Hiv Infection ◽

Immune Reconstitution Inflammatory Syndrome ◽

Immune Reconstitution ◽

Secondary Syphilis ◽

Immune Reconstitution Syndrome ◽

Clinical Expression ◽

Immunodeficiency Virus ◽

Inflammatory Syndrome

The presentation of syphilis as a manifestation of immune reconstitution inflammatory syndrome in patients with human immunodeficiency virus (HIV) infection is rare and can be associated with the varied clinical expression of unusual syphilitic manifestations. We report a case of immune reconstitution syndrome with dermatologic, ophthalmologic and neurologic compromise of secondary syphilis in a patient with HIV infection.

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Moth-Eaten Essential Syphilitic Alopecia in Human Immunodeficiency Virus-Positive Patient: A Case Report

International Journal of Clinical Case Reports and Reviews ◽

10.31579/2690-4861/111 ◽

2021 ◽

Vol 6 (5) ◽

pp. 01-03

Author(s):

Satiti Pudjiati

Keyword(s):

Human Immunodeficiency Virus ◽

Hair Loss ◽

Serological Test ◽

Secondary Syphilis ◽

Penicillin G ◽

Serological Tests ◽

Immunodeficiency Virus ◽

High Risk Sexual Behaviour ◽

Risk Sexual Behaviour ◽

Unclear Etiology

Hair loss is rare to be reported as sole manifestation of secondary syphilis. Syphilitic alopecia consists of symptomatic syphilitic alopecia that presents with other secondary syphilis manifestation, and essential syphilitic alopecia which can be patchy ("moth-eaten" type), diffuse, or combination without other manifestations of secondary syphilis. Here we report a case of secondary syphilis in patient with Human Immunodeficiency Virus (HIV) that present with moth-eaten alopecia as a sole manifestation. A 35-year-old male with HIV complained hair loss on his scalp and eyebrows. Physical examination showed non scarring moth-eaten alopecia on his scalp and lossof lateral third of his eyebrows without other lesions. Serological test for syphilis was positive. He was treated with 2.4 millions unit of benzathine penicillin G (BPG), single dose intramuscular injection. Six months after injection, patient showed clinical and serological improvement. Syphilitic alopecia cannot be ruled out in patients with non scarring hair loss with unclear etiology. Serological tests are recommended especially for patients with history of high risk sexual behaviour.

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Sexual abuse leading to secondary syphilis in an intellectually disabled person: a case report

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20214217 ◽

2021 ◽

Vol 7 (6) ◽

pp. 872

Author(s):

Rajesh Munusamy ◽

Nithin Nagaraja

Keyword(s):

Sexual Abuse ◽

Venereal Disease ◽

Treponema Pallidum ◽

Secondary Syphilis ◽

Penicillin G ◽

Intellectually Disabled ◽

Transmitted Infection ◽

Sexual Transmitted Infection ◽

Benzathine Penicillin G

Syphilis is a sexual transmitted infection (STI) caused by a spirochete, Treponema pallidum. Condylomata lata is a characteristic lesion seen in secondary syphilis. Here we reported a case of 24 year old unmarried male with intellectual disability who presented with condyloma lata over the scrotum, prepuce and perianal region and with moth eaten alopecia over scalp since 1 month. Here the patients mother revealed he had promiscuous relationship with multiple friends, which is a sexual abuse since the patient is intellectually disabled. Clinically diagnosed as secondary syphilis. Venereal disease research laboratory (VDRL) test titre was reactive at 1:32 and Treponema pallidum hemagglutination test (TPHA) was positive. Biopsy was also done, which confirmed diagnosis. Single dose of injection benzathine penicillin G, 2.4 million units was administered intramuscularly. Patient did not develop a Jarisch-herxheimer reaction. On follow up his lesions healed and VDRL titres also came down and non-reactive at 3 months. Here in this case sexual abuse lead to secondary syphilis since patient was intellectually disabled so he couldn’t address his complaints clearly. Hence counselling was done to the patient and family members by dermatologist and psychiatrist.

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Secondary syphilis presenting as erythema multiforme in a HIV-positive homosexual man: a case report and literature review

International Journal of STD & AIDS ◽

10.1177/0956462418805197 ◽

2018 ◽

Vol 30 (3) ◽

pp. 304-309

Author(s):

Hongfang Liu ◽

Beng-Tin Goh ◽

Taoyuan Huang ◽

Yinghui Liu ◽

Ruzeng Xue ◽

...

Keyword(s):

Plasma Cell ◽

Erythema Multiforme ◽

Treponema Pallidum ◽

Inflammatory Cells ◽

Secondary Syphilis ◽

Penicillin G ◽

Cell Infiltrate ◽

Early Syphilis ◽

Skin Histology ◽

Anal Warts

Early syphilis can rarely cause erythema multiforme-type eruptions as well as triggering erythema multiforme (EM). EM-like lesions in secondary syphilis are characterized by clinical features of EM and laboratory tests consistent with secondary syphilis and the skin histology shows predominantly a plasma cell infiltrate with the presence of treponemes. When EM is triggered by early syphilis, the skin histology shows mixed inflammatory cells usually in the absence of treponemes in the skin lesion. There may also be mixed histology with the presence of treponemes in the absence of a plasma cell infiltrate and vice versa. We describe a case of secondary syphilis presenting as EM with bullae and histology showing EM features without a plasma cell infiltrate but positive for Treponema pallidum by immunohistochemical staining. The patient was also coinfected with cytomegalovirus, human immunodeficiency virus, and anal warts. The EM eruptions resolved with treatment for secondary syphilis with benzathine penicillin G.

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Osteolytic lesions as the sole presenting feature of secondary syphilis

BMJ Case Reports ◽

10.1136/bcr-2021-242814 ◽

2021 ◽

Vol 14 (6) ◽

pp. e242814

Author(s):

Matthew Colquhoun ◽

Othman Kirresh ◽

Mohammad Keikha ◽

Lewis Haddow

Keyword(s):

Multidisciplinary Approach ◽

Secondary Syphilis ◽

Plain Radiography ◽

Penicillin G ◽

Newly Diagnosed ◽

Nuclear Medicine Imaging ◽

Osteolytic Lesions ◽

Multiple Regions ◽

Genitourinary Medicine ◽

Investigative Process

We present the case of a 48-year-old man with a background of well-controlled HIV who presented with bony pain in multiple regions and raised inflammatory markers. After an investigative process, the patient was newly diagnosed with secondary syphilis. Bony pain, secondary to osteolytic lesions and demonstrated on plain radiography, CT and nuclear medicine imaging, was the sole presenting feature. The patient was successfully treated with penicillin G and his symptoms improved. Rheumatologists are often tasked with diagnosing the cause of a patient’s pain. However, in this case, a multidisciplinary approach was needed and the contribution of a specialist in Genitourinary Medicine/HIV was required to help diagnose this rare cause of bony pain.

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Diffuse Hair Loss in Secondary Syphilis in HIV Positive Man: Case Report

Acta Facultatis Medicae Naissensis ◽

10.2478/v10283-012-0027-1 ◽

2012 ◽

Vol 29 (4) ◽

pp. 193-197 ◽

Cited By ~ 1

Author(s):

Milan Bjekić

Keyword(s):

Hair Loss ◽

Scalp Hair ◽

Secondary Syphilis ◽

Penicillin G ◽

Hiv Positive ◽

Oral Lesions ◽

Benzathine Penicillin ◽

Serological Tests ◽

Benzathine Penicillin G ◽

Macular Rash

SUMMARY Hair loss is not a common feature of secondary syphilis. There are two types of syphilitic alopecia: “symptomatic” type where hair loss is associated with other symptoms of secondary syphilis, and “essential” alopecia that is either patchy (“moth-eaten” type), diffuse pattern with a generalized thinning of the scalp hair, or a combination of both without any other mucocutaneous signs of syphilis. This article presents a case of syphilitic alopecia in a 30-year-old homosexual man. The patient had diffuse non-scarring alopecia of his scalp and loss of eyelashes and eyebrows. A macular rash with palmar-plantar involvement and oral lesions coexisted with the hair loss. Serological tests for syphilis were positive. The patient was treated with a single dose of benzathine penicillin G, 2.4 million units intramuscularly. Within three months there was dramatic hair regrowth, and all syphilitic lesions resolved. Patient was councelled and tested on HIV. The HIV seropositivity was confirmed by Western blot analysis. Syphilitic alopecia should not be overlooked in patients with non-scarring hair loss. Serologic testing for syphilis is recommended in patients with unexplained rapid hair loss. However, all patients presenting with syphilis should be offered HIV testing.

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Double Morphology: Tertiary Syphilis and Acquired Immunodeficiency Syndrome—A Rare Association

Case Reports in Dermatological Medicine ◽

10.1155/2017/3843174 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

R. M. Ngwanya ◽

B. Kakande ◽

N. P. Khumalo

Keyword(s):

Past History ◽

Treponema Pallidum ◽

Secondary Syphilis ◽

Penicillin G ◽

Rapid Progression ◽

Tertiary Syphilis ◽

History Of ◽

Generalized Lymphadenopathy ◽

Immunodeficiency Syndrome ◽

Cluster Of Differentiation

Background. Human immunodeficiency virus (HIV) and Treponema pallidum coinfection is relatively common and accounts for about 25% of primary and secondary syphilis. Tertiary syphilis in HIV-uninfected and HIV-infected patients is vanishingly rare. This is most likely due to early treatment of cases of primary and secondary syphilis. There is rapid progression to tertiary syphilis in HIV-infected patients. Case Presentation. A 49-year-old woman diagnosed with HIV Type 1 infection and cluster of differentiation 4 (CD4) count of 482 presented with a four-week history of multiple crusted plaques, nodules, and ulcers on her face, arms, and abdomen. Her past history revealed red painful eyes six months prior to this presentation. She had generalized lymphadenopathy, no alopecia, and no palmar-plantar or mucosal lesions. There were no features suggestive of secondary syphilis. Neurological examination was normal. Her rapid plasma reagin test was positive to a titer of 64. She was treated with Penicillin G 20 mu IVI daily for 2 weeks. Conclusion. Penicillin remains the treatment of choice in syphilitic infected HIV negative and HIV-infected individuals. In neurosyphilis, the dose of Penicillin GIVI is 18–24 mu daily for 10–14 days. This case report demonstrates the importance of excluding syphilis in any HIV-infected patient.

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