Background: One dose of benzathine penicillin G (BPG) has been recommended for HIV-infected patients with early syphilis (primary, secondary, and early latent syphilis) in the sexually transmitted diseases treatment guidelines, but clinical data to support such a recommendation are limited. Methods: We prospectively observed the serological response to 1 or 3 weekly doses of BPG in HIV-infected adults who sought treatment of early syphilis at 8 hospitals around Taiwan. Rapid plasma reagin (RPR) titers were followed every 3-6 months after treatment. The serological response was defined as a 4-fold or greater decline in RPR titers at 12 months of treatment. The missing values were treated by following the last-observed-carried-forward principle. We hypothesized that 1 dose was non-inferior to 3 weekly doses of BPG with the non-inferiority margin for the difference of serological response set to 10%. Results: Between 2007 and 2012, 573 patients completed at least 12 months of follow-up: 295 (51.5%) receiving 1 dose of BPG (1-dose group) and 278 (48.5%) 3 doses (3-dose group). Overall, 198 patients (67.1%; 95% confidence interval [CI], 61.4-72.5%) in the 1-dose group achieved serological response at 12 months, as did 208 patients (74.8%; 95% CI, 69.3-79.8%) in the 3-dose group (one-sided 95% CI of the difference, 15.1%). In the multivariate analysis, secondary syphilis (adjusted odds ratio [AOR], 1.90; 95% CI 1.17-3.09), RPR titer >= 32 (AOR, 1.93; 95% CI, 1.38-2.69), and 3 doses of BPG (AOR, 1.68; 95% CI, 1.20-2.36) were independently associated with a serological response. The time to the first episode of treatment failure was 1184 (standard deviation [SD], 70.5) and 1436 (SD, 80.0) days for 1- and 3-dose group, respectively. Conclusions: Single-dose BPG resulted in a higher serological failure rate and shorter time to treatment failure than 3 weekly doses of BPG in the treatment of early syphilis in HIV-infected patients.
[1]Far East Mem Hosp, Dept Internal Med, New Taipei City, Taiwan.
[2]Natl Cheng Kung Univ Coll Med & Hosp, Dept Internal Med, Tainan, Taiwan.
[3]Kaohsiung Med Univ, Kaohsiung Med Univ Hosp & Coll Med, Dept Internal Med, Kaohsiung, Taiwan.
[4]Kaohsiung Med Univ, Kaohsiung Municipal Ta Tung Hosp, Dept Internal Med, Kaohsiung, Taiwan.
[5]Taichung Vet Gen Hosp, Dept Internal Med, Taichung, Taiwan.
[6]I Shou Univ, E Da Hospital, Dept Internal Med, Kaohsiung, Taiwan.
[7]Chang Gung Univ, Coll Med, Kaohsiung Chang Gung Mem Hosp, Dept Internal Med, Kaohsiung, Taiwan.
[8]Chi Mei Med Ctr, Dept Internal Med, Tainan, Taiwan.
[9]Natl Taiwan Univ Hosp, Dept Internal Med, Taipei 100, Taiwan.
[10]Natl Taiwan Univ, Coll Med, Taipei 10764, Taiwan.
[11]China Med Univ Hosp, Dept Med Res, Taichung, Taiwan.
[12]China Med Univ, Taichung, Taiwan.
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