1.Human Immunodeficiency Virus-infected men who have sex with men with syphilis: A 5-year multicentre study in Malaysia
Siaw Yen Ong ; Min Moon Tang ; Izzaty Dalawi ; Wooi Chiang Tan ; Chin Aun Yeoh ; Wee Meng Kho ; Pubalan Muniandy ; Pui Li Wong ; Rukumani Devi Velayuthan ; Zhenli Kwan ; Chin Chwen Ch&rsquo ; ng ; Norli Marwyne Mohd Noor ; Vijayaletchumi Krishnasamy ; Asmah Johar
The Medical Journal of Malaysia 2020;75(4):349-355
Objectives: High rates of syphilis have been reported
worldwide among men who have sex with men (MSM). This
study aims to describe the clinical pattern and treatment
response of syphilis among human immunodeficiency virus
(HIV)-infected MSM in Malaysia.
Methods: This is a retrospective study on all HIV-infected
MSM with syphilis between 2011 and 2015. Data was collected
from case notes in five centres namely Hospital Kuala Lumpur,
Hospital Sultanah Bahiyah, Hospital Umum Sarawak,
University of Malaya Medical Centre and Hospital Sungai
Buloh.
Results: A total of 294 HIV seropositive MSM with the median
age of 29 years (range 16-66) were confirmed to have syphilis.
Nearly half (47.6%) were in the age group of 20-29 years.
About a quarter (24.1%) was previously infected with syphilis.
Eighty-three patients (28.2%) had other concomitant sexually
transmitted infection with genital warts being the most
frequently reported (17%). The number of patients with early
and late syphilis in our cohort were almost equal. The median
pre-treatment non-treponemal antibody titre (VDRL or RPR)
for early syphilis (1:64) was significantly higher than for late
syphilis (1:8) (p<0.0001). The median CD4 count and the
number of patients with CD4 <200/μl in early syphilis were
comparable to late syphilis. Nearly four-fifth (78.9%) received
benzathine-penicillin only, 5.8% doxycycline, 1.4% Cpenicillin, 1% procaine penicillin, and 12.4% a combination of
the above medications. About 44% received treatment and
were lost to follow-up. Among those who completed 1 -year
follow-up after treatment, 72.3% responded to treatment
(serological non-reactive – 18.2%, four-fold drop in titre –
10.9%; serofast – 43.6%), 8.5% failed treatment and 17% had
re-infection. Excluding those who were re-infected, lost to
follow-up and died, the rates of treatment failure were 12.1%
and 8.8% for early and late syphilis respectively (p=0.582) Conclusion: The most common stage of syphilis among MSM
with HIV was latent syphilis. Overall, about 8.5% failed
treatment at 1-year follow-up.
Result Analysis
Print
Save
E-mail