1.An epidemiological study of syphilis and predictors of treatment failure in University Malaya Medical Center
Mohamed Amin Kader ; Raja Iskandar Azwa ; Rukumani Devi Velayuthan
The Medical Journal of Malaysia 2020;75(3):199-203
Introduction: There are limited studies on the epidemiology
of syphilis in Malaysia. In this study we describe the clinical
features and treatment outcomes of patients with syphilis
attending a tertiary referral university hospital.
Methods: We retrospectively reviewed the case records of
patients with positive serology findings for syphilis in
University Malaya Medical Center (UMMC) from January
2010 to December 2015. Serological positivity was defined
as having a positive rapid plasma reagin (RPR) or Venereal
Disease Research Laboratory (VDRL) with a confirmatory
positive Treponema pallidum particle agglutination assay
(TPPA). Treatment outcomes were divided into two, success
or failure. Demographic and clinical characteristics
associated with predictors of treatment failure were
assessed using statistical package for the social science
(SPSS). This study also included a neurosyphilis descriptive
sub-study.
Results: There were 637 patients identified with positive
syphilis serology, but 258 patients were excluded as they did
not meet the inclusion criteria. 379 patients were then taken
for the demographic study; 14 patients (3.7%) were treated
for neurosyphilis; 170 patients with complete data were
included. In all 42/170 (24.7%) failed treatment, 12/170 (7.1%)
had reinfection and 116/170 (68.2%) had treatment success.
A final number of 158 patients were then taken and analyzed
for predictors of treatment failure after excluding the 12 reinfection patients. Only low baseline RPR (<1:16) was found
to be significant on multivariate logistic regression analysis
(p value: 0.007, 95% CI: 1.42, 9.21).
Conclusion: Most of the patients were HIV positive and from
the MSM (Men who have sex with Men) population. Low
baseline RPR titre is a predictor of treatment failure.
2.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.