Should syphilis be treated differently in HIV-positive and HIV-negative individuals? Treatment outcomes at a university hospital, Brighton, UK

There has been much debate regarding the optimum treatment for syphilis in HIV-positive patients. There has been a shift in expert opinion in the UK towards using two doses of benzathine penicillin G one week apart regardless of HIV status. We report our experience using a 17-day course of daily procaine penicillin plus probenecid in HIV-positive individuals and two doses of benzathine in HIV-negative patients. Of 350 cases of early syphilis, 37% were in HIV-positive individuals. Ninety-eight percent of HIV-positive patients completing the treatment were followed up for at least six months and met the criteria for treatment success. The treatment response was equally good (98%) for HIV-negative patients using these different schedules. It is currently unclear which patients require an extended course of treatment for syphilis. We have demonstrated that patients adhere well to this regimen, and significantly we have shown comparable treatment success rates in HIV-positive and -negative individuals.