HIV and syphilis: a syndemic with no end in sight?
Presented by Dr Phillip Read, Sexual Health Physician and the Acting Director of the Kirketon Road Centre in Sydney’s Kings Cross who spoke about the rising rates of Syphilis and co- infection in HIV+ve men. There are increasing rates of syphilis notifications in the MSM cohort, with more than 50% of notifications in this group. In Canada, there is a 300x increase in rates of syphilis associated with HIV infection. In OECD countries, there are increases evident in the male to female ratio of syphilis infections.
Other points that were discussed included 'PrEP' for syphilis in a proof of concept study which used doxycycline 100mg daily. It demonstrated a 73% reduction in infections, with minimal side effects.
Also, a study that showed that 2 weeks of doxycycline showed no difference in cure rates of syphilis when compared to a single benzathine dose. That's reassuring for myself when I've had to use that regimen for those who can't use penicillin. Interestingly, another study showed that a 3gm dose of amoxicillin had a 95% cure rate for syphilis.
The take home message for me was about treatment of syphilis in HIV+ve individuals. Time to come clean... I have to admit that I have always been in the '3 is better than 1' boat however a study in the U.S. Military Cohort showed no difference between 1 dose and 3 for cure. Interestingly, 40% of syphilis treatment in Australia was with enhanced therapy (ie 3 injections) vs guidelines for acute/early syphilis. So there are many in my boat, but I think it's time to jump ship.
HIVAIDS2015, Issues for primary care