{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T06:09:05Z","timestamp":1771481345375,"version":"3.50.1"},"reference-count":46,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2014,8,28]],"date-time":"2014-08-28T00:00:00Z","timestamp":1409184000000},"content-version":"vor","delay-in-days":239,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of the International AIDS Society"],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The Jarisch\u2010Herxheimer reaction, a febrile inflammatory reaction that often occurs after the first dose of chemotherapy in spirochetal diseases, may result in deleterious effects to patients with neurosyphilis and to pregnant women. A single 2\u2010g oral dose of azithromycin is an alternative treatment to benzathine penicillin G for early syphilis in areas with low macrolide resistance. With its potential anti\u2010inflammatory activity, the impact of azithromycin on the incidence of the Jarisch\u2010Herxheimer reaction in HIV\u2010positive patients with early syphilis has rarely been investigated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In HIV\u2010positive patients with early syphilis, the Jarisch\u2010Herxheimer reaction was prospectively investigated using the same data collection form in 119 patients who received benzathine penicillin G between 2007 and 2009 and 198 who received azithromycin between 2012 and 2013, when shortage of benzathine penicillin G occurred in Taiwan. Between 2012 and 2013, polymerase chain reaction (PCR) assay was performed to detect <jats:italic>Treponema pallidum<\/jats:italic> DNA in clinical specimens, and PCR restriction fragment length polymorphism of the 23S ribosomal RNA was performed to detect point mutations (2058G or A2059G) that are associated with macrolide resistance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The overall incidence of the Jarisch\u2010Herxheimer reaction was significantly lower in patients receiving azithromycin than those receiving benzathine penicillin G (14.1% vs. 56.3%, <jats:italic>p&lt;<\/jats:italic>0.001). The risk increased with higher rapid plasma reagin (RPR) titres (adjusted odds ratio [AOR] per 1\u2010log<jats:sub>2<\/jats:sub> increase, 1.21; confidence interval [CI], 1.04\u20131.41), but decreased with prior penicillin therapy for syphilis (AOR, 0.37; 95% CI, 0.19\u20130.71) and azithromycin treatment (AOR, 0.15; 95% CI, 0.08\u20130.29). During the study period, 310 specimens were obtained from 198 patients with syphilis for PCR assays, from whom <jats:italic>T. pallidum<\/jats:italic> was identified in 76 patients, one of whom (1.3%) was found to be infected with <jats:italic>T. pallidum<\/jats:italic> harbouring the macrolide resistance mutation (A2058G). In subgroup analyses confined to the 75 patients infected with <jats:italic>T. pallidum<\/jats:italic> lacking resistance mutation, a statistically significantly lower risk for the Jarisch\u2010Herxheimer reaction following azithromycin treatment was noted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Treatment with azithromycin was associated with a lower risk for the Jarisch\u2010Herxheimer reaction than that with benzathine penicillin G in HIV\u2010positive patients with early syphilis. Previous benzathine penicillin G therapy for syphilis decreased the risk, whereas higher RPR titres increased the risk, for the reaction.<\/jats:p><\/jats:sec>","DOI":"10.7448\/ias.17.1.18993","type":"journal-article","created":{"date-parts":[[2014,8,28]],"date-time":"2014-08-28T03:06:56Z","timestamp":1409195216000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Jarisch\u2010Herxheimer reaction among HIV\u2010positive patients with early syphilis: azithromycin versus benzathine penicillin G 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