Table 1

Studies that met entry criteria stratified by syphilis stage and type of treatment

StudyStudy designMedian follow-up time (months)Re-infectionInitial N (HIV-/HIV+)*Stage (HIV status)Follow-up NTreatmentSerological failuresClinical failures
Dowell (1992)10Retrospective series≥6Y56 (0/56)L (+)4913BPG X 340
36Cef X 10–14 doses90
N (+)77Cef X 10–14 doses11
Gourevitch (1993)11Retrospective cohort11.4N50 (19/31)E (−)41BPG X 100
3BPG X 1 enhanced§00
L (−)127BPG X 300
3Less than BPG X 300
1Doxy X 28d00
1Tetra X 14d10
N (−)11APG X 10–14d00
E (+)111BPG X100
10BPG X 1 enhanced§00
L (+)139BPG X 300
1Less than BPG X 300
2BPG X 3 enhanced§00
1Erythro X 28d00
N (+)22APG X 10–14d00
Caumes (1994)12Prospective series24N13 (0/13)E (+)125BPG X 200
5BPG X 300
1Doxy X 14–15d00
1Erythro X 21d00
N (+)11APG X 10–14d00
Gordon (1994)13Prospective series10N11 (0/11)N (+)1111APG X 10d31
Hutchinson (1994)14Case–control<12N309 (239/70)E (−)7878BPG X 1 or Doxy X 14d110
E (+)2828BPG X 1 or Doxy50
Goeman (1995)15Prospective cohort24N120 (73/47)U (−)3434BPG X 311NA
U (+)2626BPG 2.4 X 313NA
Malone (1995)16Retrospective series24 (mean)N59 (0/59)E (+)2111BPG 2.4 X 333
7CPG + P X 10–14d00
3APG X 10–14d00
L (+)3019BPG X 341
1Cef? Dose00
2CPG +P X 10–14d00
8APG X 10–14d00
N (+)55APG X 10–14d31
Marra (1996)17Retrospective series∼3–6N22 (9/13)N (−)95APG X 10d00
3CPG + P X 10–14d00
1CPG + P X 9d00
N (+)139APG X 10d20
4CPG + P X 10–14d10
Yinnon (1996)18Case–control∼12 (mean)N128 (64/64)E (−)2622BPG X 1
1BPG X 3
3Other15 of 520
L (−)2624BPG X 3
E (+)264BPG X 1
18BPG X 3
4other21 of 48
L (+)212BPG X 10
19BPG X 3
N (+)15other
Rolfs (1997)19RCT6Y541 (440/101)E (−)257NABPG X142 of 2570
NABPG X 1+ amox/P X 10d
E (+)69NABPG X115 of 691
NABPG X1 + amox/P X 10d
Bordón (1999)20Prospective series21N13 (0/13)E (+)44BPG X 300
L (+)51CPG X 14d1 of 50
4BPG X 3
N (+)44APG X 14d00
Hook (2002)21Randomised open label6Y74 (71/3)E (−)7119BPG X 1 or 200
21Azithro X 100
31Azithro X 230
E (+)32BPG X 1 or 200
1Azithro X 200
Tattevin (2002)22Prospective cohort∼6N23 (0/23)L (+)1111Biclinocilline 2MU IM X1 daily X 10d
N (+)11Biclinocilline 2MU IM X1 daily X 10d7 of 120
Smith (2004)23Randomised open label18–32N31 (0/31)L (+)158CPG + P X 15d10
7Cef X 15d10
N (+)92CPG +P X 15d10
7Cef X 15d20
Guitierrez-Galhardo (2005)24Prospective series24Y24 (0/24)E (+)54BPG X30
1Erythro? duration00
L (+)55BPG X 300
N (+)143APG X 14d
10Cef X 14d4 of 140
1BPG X 3
Kiddugavu (2005)25Prospective cohort∼9 (mean)N952 (754/198)E (−)88136BPG X 1
L (−)666135Azithro X 1303 of 754NA
483BPG X 1 + Azithro
E (+)4532BPG X 1
L (+)15230Azithro X 169 of 198NA
136BPG X 1 + Azithro
Nnoruka (2005)26Prospective series12N31 (0/31)E (+)99BPG X 35 of 102 of 10
L (+)11Doxy X 15d
Riedner (2005)27Randomised double-blinded9N328 (157/171)E (−)15778BPG X 130
79Azithro X 100
E (+)17187BPG X 160
84Azithro X 140
Chauhan (2006)28Retrospective series12N40 (34/6)E (−)312BPG X 100
24BPG X 200
2BPG X1 + Doxy X 14d00
2Doxy X 14d00
1CPG X 10d00
E (+)53BPG X 300
2Doxy X 14d00
N (+)11CPG + P X 17d00
Kofoed (2006)29Prospective series7N41 (0/41)E (+)284BPG X 300
15Doxy X 14d10
9CPG X 10d10
L (+)123BPG X 300
9Doxy X 14d22
Ghanem (2007)30Retrospective series9Y297 (168/129)E (−)152151BPG X 140
1Doxy X 14d00
L (−)1414BPG X 310
E (+)3231BPG X 140
1Doxy X 14d00
L (+)9693BPG X 3180
3Doxy X 28d00
Manavi (2007)31Retrospective series24Y371 (242/129)E (−)18123BPG X 1
L (−)6139BPG X 2
113BPG X 358 of 161
41Doxy X 21dHIV- @ 24m
5CPG X 17d
E (+)674BPG X 1
L (+)6213BPG X 2
61BPG X 3
16Doxy X21d30 of 100
1Azithr1 g X15dHIV+
16CPG X 17d@ 24 m
1APG x 14d
Ghanem (2008)32Retrospective cohort63.6Y231 (0/231)E (+)6249BPG X 1110
1BPG X 24 of 110
10BPG X 3
1Doxy X 14d00
1APG X 10–14d00
L (+)1285BPG X 100
4BPG X 200
103BPG X 3320
7Doxy X 21d20
1Cef X 10d00
N (+)4136APG X 10–14d101
5Cef X 10d10
Warwick (2008)33Retrospective series6N257 (132/125)E (−)132132BPG X 13N/A
E (+)125105CPG+P X 17d1N/A
  • * Total number of people who completed follow-up.

  • N=the subset of people who had follow-up data available.

  • Serological failure in this study was defined as complete rapid plasma reagin seroreversion. No data on fourfold decline were provided.

  • § Enhanced with additional doses of penicillin (but dose not provided).

  • Re-infection, the study examined whether failure might have been due to re-infection.

  • E, early-stage syphilis (primary, secondary, or early latent); L, late latent syphilis stage or syphilis stage of unknown duration; N, neurosyphilis. Amox, amoxicillin 2 g daily orally; APG, aqueous penicillin 18–24 million units intravenously daily; Azithro, azithromycin 2 g orally unless otherwise noted; BPG, benzathine penicillin G 2.4 million units given intramuscularly; Cef, ceftriaxone 1–2 g intramuscularly or intravenously; CPG, procaine penicillin 2.4 million units intramuscularly; d, days; Doxy, doxycycline 100 mg orally twice a day; erythro, erythromycin 3 g daily orally; IM, intramuscularly; m, months; MU, million units; P, probenecid 500 mg orally four times daily; Tetra, tetracycline 500 mg orally four times daily; U, unknown stage.