Document 0752
 DOCN  M9470752
 TI    Altered clinical presentation of early syphilis in patients with human
       immunodeficiency virus infection.
 DT    9409
 AU    Hutchinson CM; Hook EW 3rd; Shepherd M; Verley J; Rompalo AM; Johns
       Hopkins University School of Medicine, Baltimore, Maryland.
 SO    Ann Intern Med. 1994 Jul 15;121(2):94-100. Unique Identifier : AIDSLINE
       MED/94288395
 AB    OBJECTIVES: To compare clinical presentations of patients with early
       syphilis who did or did not have human immunodeficiency virus (HIV)
       infection. DESIGN: Case-control study. SETTING: The sexually transmitted
       diseases clinics of the Baltimore City Health Department. PATIENTS:
       Patients with newly diagnosed primary, secondary, or early latent
       syphilis who had voluntary HIV testing from January 1990 to November
       1991. MEASUREMENTS: Data on sexual history, risk behaviors, and physical
       findings (before knowledge of HIV or syphilis serologic test results)
       were extracted from clinical records. Diagnoses of syphilis were
       confirmed by reactive syphilis serologic tests. Rapid plasma reagin
       titers reported to the disease registry of the Baltimore City Health
       Department were abstracted to determine therapeutic response. Patients
       positive for HIV who returned for follow-up had further counseling,
       staging, and CD4 lymphocyte testing. RESULTS: Data were available on 309
       of 527 patients with early syphilis: 108 patients with primary syphilis,
       116 with secondary syphilis, and 85 with early latent syphilis. Seventy
       (23%) patients had concurrent HIV infection. Patients with HIV infection
       presented more often with secondary syphilis than did patients with
       syphilis who were HIV seronegative (53% [37 of 70] compared with 33% [79
       of 239]; P = 0.01). The same was true for heterosexual men with HIV
       infection (46% [16 of 35]) compared with heterosexual men without
       infection (25% [35 of 142]; P < 0.03). Among those who denied
       intravenous drug use, 59% (22 of 37) of patients with HIV infection
       presented with secondary syphilis compared with 33% (65 of 198) of
       patients without infection (P < 0.01). Among patients with first
       episodes of syphilis, patients positive for HIV who had secondary
       syphilis were more likely to present with persistent chancres (43% [9 of
       21] compared with 15% [11 of 72]; P = 0.01). The rate of decline in the
       rapid plasma reagin titers during a 12-month period after treatment did
       not differ between patients with and without HIV infection (P = 0.15).
       CONCLUSIONS: The clinical presentation of syphilis in patients with HIV
       infection differs from that of patients without HIV infection in that
       patients with HIV infection present more often in the secondary stage
       and those with secondary syphilis are more likely to have chancres.
 DE    Adult  Case-Control Studies  Female  Human  HIV
       Infections/COMPLICATIONS/*IMMUNOLOGY  Leukocyte Count  Male
       Reagins/BLOOD  Risk Factors  Sex Behavior  Substance Abuse,
       Intravenous/COMPLICATIONS  Support, U.S. Gov't, P.H.S.
       Syphilis/COMPLICATIONS/*IMMUNOLOGY  Syphilis Serodiagnosis/METHODS  T4
       Lymphocytes  JOURNAL ARTICLE

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