A Pilot Study Evaluating Ceftriaxone and Penicillin G as Treatment Agents for Neurosyphilis in Human Immunodeficiency Virus-Infected Individuals

• Published in: Clinical infectious diseases Vol. 30; no. 3; pp. 540 - 544
• Main Authors: Marra, C. M., Boutin, P., McArthur, J. C., Hurwitz, S., Simpson, G., Haslett, J. P. A., van der Horst, C., Nevin, T., Hook, E. W.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01-03-2000; University of Chicago Press
• Subjects: Adult; AIDS; AIDS/HIV; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Ceftriaxone - therapeutic use; Cephalosporins - therapeutic use; Clinical Articles; Female; HIV; HIV Infections - complications; Human immunodeficiency virus 1; Humans; Infectious diseases; Male; Medical sciences; Medicine; Middle Aged; Nervous system diseases; Neurosyphilis; Neurosyphilis - drug therapy; Neurosyphilis - microbiology; Penicillin; Penicillin G - therapeutic use; Penicillins - therapeutic use; Pharmacology. Drug treatments; Pilot Projects; Reagins; Symptoms; Treponema pallidum; Wasserman test; Intravenous administration; HIV-1 virus; Nervous system; Ceftriaxone; Penicillin derivatives; Syphilis; Penicillin; Bacteria; Complication; Spirachaetosis; Treponema pallidum; Human; Immunopathology; Nervous system diseases; Spirochaetales; β-Lactams; Retroviridae; AIDS; Immune deficiency; Lentivirus; Treponematosis; Infection; Virus; Antibiotic; Chemotherapy; Cephalosporin derivatives; Sexually transmitted disease; Treatment; Viral disease; Bacteriosis; Human immunodeficiency virus; Treponemataceae; Antibacterial agent; Comparative study
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/313725

To compare intravenous (iv) ceftriaxone and penicillin G as therapy for neurosyphilis, blood and CSF were collected before and 14–26 weeks after therapy from 30 subjects infected with human immunodeficiency virus (HIV)-1 who had (1) rapid plasma reagin (RPR) test titers ≥1 : 16, (2) reactive serum treponemal tests, and (3) either reactive CSF-Venereal Disease Research Laboratory (VDRL) tests or CSF abnormalities: (a) CSF WBC values ≥20/µL or (b) CSF protein values ≥50 mg/dL. At baseline, more ceftriaxone recipients had skin symptoms and signs (6 [43%] of 14 vs. 1 [6%] of 16; P = .03), and more penicillin recipients had a history of neurosyphilis (7 [44%] of 16 vs. 1 [7%] of 14; P = .04). There was no difference in the proportion of subjects in each group whose CSF measures improved. Significantly more ceftriaxone recipients had a decline in serum RPR titers (8 [80%] of 10 vs. 2 [13%] of 15; P = .003), even after controlling for baseline RPR titer, skin symptoms and signs, or prior neurosyphilis were controlled for. Differences in the 2 groups limit comparisons between them. However, iv ceftriaxone may be an alternative to penicillin for treatment of HIV-infected patients with neurosyphilis and concomitant early syphilis.