O Niragira1, S Ha1, L Pogany1, A Singh2. 1. Centre for Communicable Diseases and Infection Control, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, ON. 2. University of Alberta, Department of Medicine, Edmonton, AB.
Abstract
BACKGROUND: The optimal treatment for syphilis in people who are human immunodeficiency virus (HIV) positive is controversial. OBJECTIVE: To assess the efficacy of three doses versus a single dose of long acting Benzathine Penicillin G (BP-G) for the effective management of early syphilis among HIV co-infected populations. METHODS: A systematic search of the published literature was conducted using MEDLINE and EMBASE databases to identify clinical and observational studies published between January 2010 and May 2015. Inclusion criteria were: publication in English or French, populations co-infected with HIV and early syphilis, treatment with BP-G and outcomes related to syphilis treatment. All articles underwent a risk of bias assessment and data extraction was completed on all included studies. RESULTS: Seven studies were eligible for final inclusion, data extraction and analysis. The evidence from the final included studies were from non-randomized controlled trials. In general, no significant differences were found between groups treated with one versus two or more doses of BP-G; but there was a trend toward longer time to treatment failure with three doses. Differences in methodology limit the ability to draw any firm conclusions on the relative efficacy between these two treatment regimens. CONCLUSION: Insufficient data exist to ascertain whether or not there is an added benefit from additional doses of BP-G for the treatment of early syphilis with HIV co-infection. A high-quality, randomized controlled trial is needed to definitively nswer this question.
BACKGROUND: The optimal treatment for syphilis in people who are human immunodeficiency virus (HIV) positive is controversial. OBJECTIVE: To assess the efficacy of three doses versus a single dose of long acting Benzathine Penicillin G (BP-G) for the effective management of early syphilis among HIV co-infected populations. METHODS: A systematic search of the published literature was conducted using MEDLINE and EMBASE databases to identify clinical and observational studies published between January 2010 and May 2015. Inclusion criteria were: publication in English or French, populations co-infected with HIV and early syphilis, treatment with BP-G and outcomes related to syphilis treatment. All articles underwent a risk of bias assessment and data extraction was completed on all included studies. RESULTS: Seven studies were eligible for final inclusion, data extraction and analysis. The evidence from the final included studies were from non-randomized controlled trials. In general, no significant differences were found between groups treated with one versus two or more doses of BP-G; but there was a trend toward longer time to treatment failure with three doses. Differences in methodology limit the ability to draw any firm conclusions on the relative efficacy between these two treatment regimens. CONCLUSION: Insufficient data exist to ascertain whether or not there is an added benefit from additional doses of BP-G for the treatment of early syphilis with HIV co-infection. A high-quality, randomized controlled trial is needed to definitively nswer this question.
Authors: E G Muldoon; B Mooka; D Reidy; S O'Dea; S Clarke; G Courtney; F Lyons; C Bergin; F Mulcahy Journal: Int J STD AIDS Date: 2012-09 Impact factor: 1.359
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