Treatment success and associated factors in unknown stage syphilis treated with standard regimen in Nakornping hospital
Keywords:
unknown stage syphilis, standard treatment regimen, response, HIV, RPRAbstract
Objective: To study the treatment result and associated factors in unknown stage syphilis treated with standard treatment regimen
Method: A retrospective cohort study was conducted among all unknown stage syphilitic patients in Nakornping hospital from 1st October 2019 – 31st May 2020. The patients had received a standard treatment with Benzathine penicillin 2.4 million units intramuscularly, once per week for 3 weeks. Demographic data, HIV status, baseline and after treatment serum rapid plasma reagin (RPR) were collected. The treatment response was defined as decreased RPR titer more than 4 fold from baseline. Cox proportional hazard model was used to evaluate a treatment response and associated factors.
Result: Ninety-four patients were enrolled in this study, 74 cases had response to the treatment (78.7%). Gender and age were not associated with treatment response. We found that serologic cure was not associated with gender, age and race. There were significant association in HIV infection; Adj. HR 0.53, 95% CI 0.31-0.89, p - value = 0.016 and baseline RPR titer ≥ 1:8; Adj. HR 6.39, 95% CI 2.30-17.77, p - value < 0.001.
Conclusion: This study had confirmed a notable serologic cure in syphilis patients treated with standard regimen. However, HIV status and low baseline RPR titer had associated with slow response in serology.
References
Clement ME, Okeke NL, Hicks CB. Treatment of syphilis: a systematic review. JAMA. 2014;312(18):1905-1917.
Ministry of Public Health, Department of Disease Control, Bureau of AIDS and Tuberculosis And sexually transmitted diseases. Treatment guidelines for sexually transmitted diseases: 2015. Bangkok: Aksorn Graphic and Design; 2015. (In Thai)
Ministry of Public Health, Department of Disease Control, Bureau of AIDS and Tuberculosis And sexually transmitted diseases. Annual report of the Bureau of AIDS, Tuberculosis And sexually transmitted diseases: 2017. Bangkok: J. S. Publishing; 2017. (In Thai)
Medical Record Unit, Nakornping Hospital, Patient data document (unpublished manuscript), 2019. (In Thai)
World Health Organization. WHO guidelines for the treatment of Treponema pallidum (syphilis). Switzerland: World Health Organization; 2016.
Peeling RW, Mabey D, Kamb ML, Chen X-S, Radolf JD, Benzaken AS. Syphilis. Nat Rev Dis Primers. 2017;3:17073.
STI Guideline Development Group. WHO guidelines for the treatment of Treponema pallidum (syphilis). Geneva: the WHO Document Production Services; 2016.
Ghanem KG, Erbelding EJ, Wiener ZS, Rompalo AM. Serological response to syphilis treatment in HIV-positive and HIV-negative patients attending sexually transmitted diseases clinics. Sex Transm Infect. 2007;83(2):97–101.
Manavi K, McMillan A. The outcome of treatment of early latent syphilis and syphilis with undetermined duration in HIV-infected and HIV-uninfected patients. Int J STD AIDS. 2007;18(12):814–818.
González-López JJ, Guerrero ML, Luján R, Tostado SF, de Górgolas M, Requena L. Factors determining serologic response to treatment in patients with syphilis. Clin Infect Dis. 2009;49(10):1505–1511.
Knaute DF, Graf N, Lautenschlager S, Weber R, Bosshard PP. Serological response to treatment of syphilis according to disease stage and HIV status. Clin Infect Dis. 2012;55(12):1615–1622.
Seña AC, Wolff M, Behets F, Van Damme K, Martin DH, Leone P, et al. Response to therapy following retreatment of serofast early syphilis patients with benzathine penicillin. Clin Infect Dis. 2013;56(3):420–422.
Agmon-Levin N, Elbirt D, Asher I, Gradestein S, Werner B, Sthoeger Z. Syphilis and HIV co-infection in an Israeli HIV clinic: incidence and outcome. Int J STD AIDS. 2010;21(4):249–252.
Seña AC, Wolff M, Martin DH, Behets F, Van Damme K, Leone P, et al. Predictors of serological cure and serofast state after treatment in HIV-negative persons with early syphilis. Clin Infect Dis. 2011;53(11):1092–1099.
Tong ML, Lin LR, Liu GL, Zhang HL, Zeng YL, Zheng WH, et al. Factors Associated with Serological Cure and Serofast State of HIV-Negative Patients with Primary, Secondary, Latent, and Tertiary Syphilis. PLos One. 2013;8(7):e70102.
Baker-Zander SA, Shaffer JM, Lukehart SA. VDRL antibodies enhance phagocytosis of Treponema pallidum by macrophages. J Infect Dis. 1993;167(5):1100–1105.
Salazar JC, Hazlett KR, Radolf JD. The immune response to infection with Treponema pallidum, the stealth pathogen. Microbes Infect. 2002;4(11):1133–1140.
Brown ST, Zaidi A, Larsen SA, Reynolds GH. Serological response to syphilis treatment: a new analysis of old data. JAMA. 1985;253(9):1296–1299.
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