Syphilis and HIV Infection: an Update

Neuro-Ophthalmic Manifestations of HIV Infection

Purpose: To review the broad spectrum of clinical neuro-ophthalmic presentations associated with human immunodeficiency virus (HIV) infection. Methods: Critical review of the literature regarding neuro-ophthalmic consequences of HIV infection and its sequelae. Results: Neuro-ophthalmological diseases are common in both asymptomatic HIV-positive patients and those who profound immunosuppression with acquired immune deficiency syndrome (AIDS). Neuro-ophthalmic manifestations of HIV infection can involve the afferent or efferent visual pathway. Common clinical presentations include headache, papilledema, chorioretinitis, optic nerve involvement, meningitis, and cranial nerve palsies. Other neuro-ophthalmic manifestations include involvement of the visual pathway in the brain producing visual field defects such as occur in progressive multifocal encephalopathy. Pupil abnormalities have also been reported. Discussion: Neuro-ophthalmic consequences of HIV are important to recognize as it is critical to identify underlying neoplastic or infectious diseases which could be amenable to treatment.

Nodulo-ulcerative and erythrodermic secondary syphilis in human immunodeficiency virus-infected individuals

Syphilis and human immunodeficiency virus (HIV) infections are both transmitted sexually. Co-infection of HIV and syphilis alters the course of both diseases. Clinical presentation of syphilis in patients of HIV may be atypical. HIV-infected individuals are at risk of developing lues maligna, which is characterized by nodulo-ulcerative lesions associated with severe constitutional symptoms. Erythroderma secondary to generalized papulo-squamous lesions of secondary syphilis is also uncommon. Here we report two cases of atypical presentations of secondary syphilis in HIV-positive patients.

Syphilis among Female Sex Workers: Results of Point-of-Care Screening during a Cross-Sectional Behavioral Survey in Burkina Faso, West Africa

Background

Syphilis among female sex workers (FSW) remains a public health concern due to its potential impact on their health and the possibility of transmission to their clients, partners, and children. Recent data on the prevalence of syphilis in the population in West Africa are scarce. The objective of this study was to measure the seroprevalence of syphilis serological markers among female sex workers in Burkina Faso.

Methods

We conducted a cross-sectional survey among FSW between February 2013 and May 2014. Participants were recruited using respondent-driven sampling (RDS) methods in five cities of Burkina Faso (Ouagadougou, Bobo-Dioulasso, Koudougou, Ouahigouya, and Tenkodogo). FSW were enrolled and screened for syphilis using a syphilis serological rapid diagnostic test. Data from all cities were analyzed with Stata version 14.0.

Results

A total of 1045 FSW were screened for syphilis. Participants' mean age was 27.2 ± 0.2 years. The syphilis serological markers were detected in 5.6% (95% CI: 4.4–7.2) of the participants whereas active syphilis was seen in 1.4% (95% CI: 0.9–2.4). RDS weighted prevalence of syphilis serological markers and active syphilis by city were, respectively, estimated to be 0.0% to 11.0% (95% CI: 8.1–14.7) and 0.0% to 2.2% (95% CI: 1.1–4.4). No syphilis markers were found among Ouahigouya FSW. Low education level and high number of clients were factors associated with syphilis markers among the FSW.

Conclusion

The prevalence of syphilis markers was high during this study among FSW. This highlights the need to reinforce the comprehensive preventive measures and treatment of syphilis in this population.

Changes in Prevalence of HIV or Syphilis among Male Sex Workers and Non-Commercial Men Who Have Sex with Men in Shenzhen, China: Results of a Second Survey

BACKGROUND

A previous time-location sampling survey (TLS) was performed in 2008 to evaluate the HIV or syphilis infection rate among male sex workers (MSWs) and non-commercial men who have sex with men (ncMSM) in Shenzhen, China. This is a second TLS performed in 2014. This article describes the findings and changes in the prevalence of HIV and syphilis.

METHODS

TLS was used to collect information as a second cross-sectional survey to an earlier TLS assessment. Data on behavior (e.g., sexual history and sexual behavior) were analyzed. Blood specimens were drawn for HIV and syphilis testing. To determine the changes in the prevalence of HIV and syphilis, we analyzed these results and compared them to the results of our first survey.

RESULTS

A total of 965 participants were recruited, including 489 MSWs and 476 ncMSM. Overall, the prevalence of HIV was 9.7%: 2.9% for MSWs and 16.8% for ncMSM (P<0.001). 10.9% of the 965 participants tested positive for syphilis: 4.5% among MSWs and 17.4% among ncMSM (P<0.001). The HIV prevalence in MSWs decreased from 4.5% in 2008 to 2.9% in 2014 (P = 0.143) but increased in ncMSM (7.0% in 2008 vs 16.8% in 2014, P<0.001). Decreased syphilis rates were observed in both MSWs (12.9% in 2008 vs 4.5% in 2014, P<0.001) and ncMSM (20.2% in 2008 vs 17.4% in 2014, P = 0.221).

CONCLUSIONS

Overall, there was a decline in the prevalence of HIV and syphilis in MSWs but not in ncMSM. The study indicated the need for continued efforts to improve public health, particularly to counter the rising rate of HIV in ncMSM.

Rising Syphilis Infection among Rural HIV-Infected Men who Routinely Received Risk-Reduction Counseling: New Challenges to HIV Prevention in Clinical Care

OBJECTIVE

Syphilis incidence has been steadily increasing among HIV-infected men in the United States, representing an important public health challenge to HIV prevention. Clinic-based HIV prevention interventions are available but may need to be revisited in response to syphilis epidemic. We wanted to better understand the current epidemiology of syphilis in rural HIV-infected men who routinely received HIV risk-reduction counseling in order to plan more effective HIV prevention strategies in clinical care.

METHODS

We conducted a retrospective cohort study to examine factors associated with syphilis infections in rural HIV-infected men who received sexually transmitted disease screening and HIV risk-reduction counseling during HIV primary care from January 2008 to June 2013. We assessed patients' demographic, clinical, behavioral and psychosocial characteristics and performed a multivariable exact logistic regression to identify factors related to syphilis.

RESULTS

Despite routine risk screening and HIV risk-reduction counseling, a total of 51 syphilis infections were diagnosed among 702 HIV-infected men (5 patients were diagnosed ≥ 2 episodes). The majority of the study participants was sexually active and reported at least one unsafe sexual behavior, mainly inconsistent condom use. Younger age (<35 years, adjusted odds ratio (aOR)=3.09), higher educational attainment (some college or above, aOR=3.72), and perception that the partner may have sex with other people (aOR=3.10) were significantly associated with syphilis infection. Non-injection drug use was related to syphilis in HIV-infected men who have sex with men (aOR=2.86).

DISCUSSION

Some HIV-infected men, especially young, educated men, or those who perceived that their partners may have sex with other people, continue to have high-risk behaviors that increase their own risks of acquiring syphilis and may also facilitate HIV transmission. New strategies need to be developed for HIV primary care providers to help HIV-infected patients maintain safer sex practices.

The impact of human immunodeficiency virus-related diseases on pigmented skin types

Infection with human immunodeficiency virus (HIV) remains a significant problem globally. Early diagnosis and treatment with antiretroviral drugs has considerably improved health outcomes and decreased disease-related morbidity. HIV infection is associated with a wide range of skin disorders enabling dermatologists to diagnose HIV as well as associated opportunistic infections early in the course of disease. Despite concerted efforts by international health organizations to limit disease incidence, the prevalence of HIV infection remains high and is highest in sub-Saharan Africa. The diagnosis of HIV-related skin diseases is challenging as immunosuppression often results in atypical disease presentation. In addition, the clinical presentation will vary in pigmented skin types. The aim of this article is to describe disease variation in pigmented skin types.