The studies included in this
PhD thesis examined the interactions of syphilis, which is caused by Treponema
pallidum, and HIV. Syphilis reemerged worldwide in the late 1990s and hereafter
increasing rates of early syphilis were also reported in Denmark.
The
proportion of patients with concurrent HIV has been substantial, ranging from
one third to almost two thirds of patients diagnosed with syphilis some years.
Given that syphilis facilitates transmission and acquisition of HIV the two
sexually transmitted diseases are of major public health concern. Further,
syphilis has a negative impact on HIV infection, resulting in increasing viral
loads and decreasing CD4 cell counts during syphilis infection.
Likewise, HIV
has an impact on the clinical course of syphilis; patients with concurrent HIV
are thought to be at increased risk of neurological complications and treatment
failure. Almost ten per cent of Danish men with syphilis acquired HIV infection
within five years after they were diagnosed with syphilis during an 11-year
study period. Interestingly, the risk of HIV declined during the later part of
the period.
Moreover, HIV-infected men had a substantial increased risk of
re-infection with syphilis compared to HIV-uninfected men. As one third of the
HIV-infected patients had viral loads >1,000 copies/ml, our conclusion
supported the initiation of cART in more HIV-infected MSM to reduce HIV
transmission.
During a five-year study period, including the majority of
HIV-infected patients from the Copenhagen area, we observed that syphilis was
diagnosed in the primary, secondary, early and late latent stage. These
patients were treated with either doxycycline or penicillin and the rate of
treatment failure was similar in the two groups, indicating that doxycycline can
be used as a treatment alternative - at least in an HIV-infected population.
During a four-year study period, the T. pallidum strain type distribution was
investigated among patients diagnosed by PCR testing of material from genital
lesions. In total, 22 strain types were identified. HIV-infected patients
were diagnosed with nine different strains types and a difference by HIV status
was not observed indicating that HIV-infected patients did not belong to
separate sexual networks.
In conclusion, concurrent HIV remains common in
patients diagnosed with syphilis in Denmark, both in those diagnosed by
serological testing and PCR testing. Although the rate of syphilis has
stabilized in recent years, a spread to low-risk groups is of concern,
especially due to the complex symptomatology of syphilis. However, given the
efficient treatment options and the targeted screening of pregnant women and
persons at higher risk of syphilis, control of the infection seems within
reach. Avoiding new HIV infections is the major challenge and here cART may
play a prominent role.
Full (PDF) article at:
By: Kirsten Salado-Rasmussen
Correspondence: Department of Infectious Diseases,
Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen. Denmark E-mail:
ksalado@hotmail.com
More at: https://twitter.com/hiv_insight
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