Article Text

Download PDFPDF

O32 Asymptomatic neurosyphilis is unlikely in hiv infected patients after treatment for early syphilis with benzathine penicillin g
  1. Andrew Tomkins,
  2. Shazaad Ahmad,
  3. Darren E Cousins,
  4. Francisco Javier Vilar,
  5. Stephen P Higgins
  1. North Manchester General Hospital, Manchester, UK


Background/introduction Benzathine penicillin G (BPG) does not cross the blood-brain barrier. Some experts believe that BPG may be ineffective when treating patients co-infected with HIV and syphilis.

Aim(s)/objectives To establish the risk of asymptomatic neurosyphilis (ANS) after treatment of early syphilis in HIV positive patients with single dose BPG.

Methods HIV patients with early syphilis were offered a post-treatment lumbar puncture if their CD4 count was <350 and/or their serum RPR >16. Patients with clinical neurosyphilis were excluded. ANS was defined as a positive CSF RPR, or CSF white blood cells >20/mm3 plus CSF TPPA >1:320.

Results 64 patients participated (median CD4 417/mm3, range 84–1100). 50 of the patients were treated with single dose BPG. Only one patient had ANS (prevalence 1.56% 95 CI 0.04–8.4) with CSF RPR negative, CSF TPPA 1:1280 and lymphocytes 45/mm3. Two patients had a pleocytosis (50 and 22 white cells/mm3 respectively) with negative CSF RPR and CSF TPPA and thus did not meet diagnostic criteria for ANS per protocol.

Discussion/conclusion Our study suggests that single dose BPG is effective treatment for early syphilis in HIV co-infected patients. We will present more data to support this conclusion.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.