FEATURES OF SYPHILIS IN HIV-INFECTION

Among HIV infected patients there is an almost 50% prevalence of reactive syphilis tests. 2 to 5% of all HIV+ patients have to be treated for syphilis. Serologic controls for syphilis are a must in these patients and should be repeated every 6 months. Patients with syphilis may have acquired HIV infection on the same occasion. They should be investigated for HIV-antibodies at least 3 and 6 months after syphilis episodes (late seroconversion for HIV antibodies!). Serological response to syphilis might be abnormal and has to be correlated with clinical findings very carefully. Special clinical features in HIV-infected patients are painful and persistant primary chancres, itching syphilides, syphilis maligna, frequent and precocious neurosyphilis, precocious tertiary syphilis. Benzathine penicilline and erythromycin are not safe in the treatment of neurosyphilis. Any suspicion of neurosyphilis should be confirmed by CSF analysis and treated by high doses of penicilline intravenously.