{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T21:19:40Z","timestamp":1761513580239,"version":"build-2065373602"},"reference-count":48,"publisher":"CSIRO Publishing","issue":"2","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":3867,"URL":"https:\/\/doi.org\/10.1071\/journalslicense"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,4,21]]},"abstract":"<jats:p>Since the turn of the millennium a sustained outbreak of syphilis among men who have sex with men continues, approximately 20\u201350% of whom have concurrent HIV infection. In this paper we aim to explore the controversies that exist around the management of syphilis in HIV-positive individuals. Not only do HIV-positive people have different clinical manifestations of syphilis they have higher rates of asymptomatic neurological involvement, slower serological response to treatment and higher serological failure than HIV-negative individuals in most studies. Whether long-term clinical outcomes are different or affected by the antibiotic regimen selected remains to be established. The optimal antimicrobial regimen to treat syphilis in HIV is unknown due to a dearth of randomised controlled trial data. International guidelines state that the antibiotic management of syphilis is the same regardless of HIV status, with early syphilis treated with a single dose of benzathine penicillin G 2.4mU intrmuscularly. In practice, however, the majority of surveyed clinicians do treat HIV-positive people with more intensive antibiotics suggesting a lack of faith in guidelines. Factors which appear to affect the likelihood of developing neurological disease include CD4+ count of &amp;lt;350 cells\/\u00b5L, absence of antiretroviral therapy, rapid plasma regain (RPR) or venereal diseases reference laboratory titre (VDRL) &amp;gt;1 : 32, late-latent disease or lack of response to standard antibiotic treatment. We recommend a low-threshold for offering antibiotic treatment effective against neurosyphilis in HIV-positive people with syphilis, especially if they exhibit any of the above factors.<\/jats:p>","DOI":"10.1071\/sh14168","type":"journal-article","created":{"date-parts":[[2015,1,26]],"date-time":"2015-01-26T16:57:54Z","timestamp":1422291474000},"page":"135-140","source":"Crossref","is-referenced-by-count":6,"title":["Management of syphilis in HIV-positive individuals"],"prefix":"10.1071","volume":"12","author":[{"given":"Fiona V.","family":"Cresswell","sequence":"first","affiliation":[{"name":"ALawson Unit, Department of HIV and Sexual Health, Brighton and Sussex University Hospitals, Eastern Road, Brighton, BN2 5BE, United Kingdom."},{"name":"CCorresponding author. Email: fiona.cresswell@bsuh.nhs.uk"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Fisher","sequence":"additional","affiliation":[{"name":"ALawson Unit, Department of HIV and Sexual Health, Brighton and Sussex University Hospitals, Eastern Road, Brighton, BN2 5BE, United Kingdom."},{"name":"BBrighton and Sussex Medical School, University Teaching Building, University of Sussex, Brighton, BN1 9PX, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"67","published-online":{"date-parts":[[2015,1,27]]},"reference":[{"key":"2025102617113950600_R1","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1111\/j.1445-5994.2012.02814.x","article-title":"Clinical aspects of adult syphilis.","volume":"42","author":"Read","year":"2012","journal-title":"Intern Med J"},{"key":"2025102617113950600_R2","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1097\/OLQ.0b013e3181b6f0cc","article-title":"Syphilis epidemiology and clinical outcomes in HIV-infected and HIV-uninfected patients in Kaiser Permanente Northern California.","volume":"37","author":"Horberg","year":"2010","journal-title":"Sex Transm Dis"},{"key":"2025102617113950600_R3","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1177\/0956462413512804","article-title":"Prevalence of syphilis infection and associations with sexual risk behaviours among HIV-positive men who have sex with men in Shanghai, China.","volume":"25","author":"He","year":"2014","journal-title":"Int J STD AIDS"},{"key":"2025102617113950600_R4","doi-asserted-by":"publisher","first-page":"1406","DOI":"10.1007\/s10461-012-0405-9","article-title":"Syphilis among men who have sex with men (MSM) in Taiwan: its association with HIV prevalence, awareness of HIV status, and use of antiretroviral therapy.","volume":"17","author":"Huang","year":"2013","journal-title":"AIDS Behav"},{"issue":"Suppl 1","key":"2025102617113950600_R5","doi-asserted-by":"publisher","first-page":"A227","DOI":"10.1136\/sextrans-2013-051184.0707","article-title":"Syphilis and HIV co-infection in patients attending an AIDS outpatient clinic in Vitoria, Brazil.","volume":"89","author":"Miranda","year":"2013","journal-title":"Sex Transm Infect"},{"key":"2025102617113950600_R6","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.1086\/513427","article-title":"Syphilis and HIV infection: an update.","volume":"44","author":"Zetola","year":"2007","journal-title":"Clin Infect Dis"},{"key":"2025102617113950600_R7","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.2165\/00003495-200262100-00003","article-title":"Mangement issues in syphilis.","volume":"62","author":"Pao","year":"2002","journal-title":"Drugs"},{"issue":"Suppl 1","key":"2025102617113950600_R8","doi-asserted-by":"publisher","first-page":"A211","DOI":"10.1136\/sextrans-2013-051184.0658","article-title":"Recent syphilis predicts hepatitis C cirus (HCV) seroconversion among HIV-positive men who have sex with men (MSM).","volume":"89","author":"Burchell","year":"2013","journal-title":"Sex Transm Infect"},{"key":"2025102617113950600_R9","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1001\/archinternmed.2012.2706","article-title":"Effect of early syphilis infection on plasma viral load and CD4 cell count in human immunodeficiency virus-infected men: results from the FHDH-ANRS CO4 cohort.","volume":"172","author":"Jarzebowski","year":"2012","journal-title":"Arch Intern Med"},{"key":"2025102617113950600_R10","doi-asserted-by":"publisher","first-page":"4584","DOI":"10.1172\/JCI57173","article-title":"Syphilis: using modern approaches to understand an old disease.","volume":"121","author":"Ho","year":"2011","journal-title":"J Clin Invest"},{"key":"2025102617113950600_R11","doi-asserted-by":"publisher","first-page":"1526","DOI":"10.1086\/644737","article-title":"Dilemmas in the management of syphilis: a survey of infectious diseases experts.","volume":"49","author":"Dowell","year":"2009","journal-title":"Clin Infect Dis"},{"key":"2025102617113950600_R12","unstructured":"Fisher M. 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