Clinical Aspects of Syphilis Reinfection in HIV-Infected Patients

Abstract

Background: The incidence of HIV-syphilis co-infection has risen since 2000, especially among men having sex with men (MSM). Syphilis reinfection can occur, but the clinical features of such events remain poorly characterized.

Objective: To compare the cutaneous lesions seen with syphilis reinfections with those of first episodes in HIV-infected patients.

Methods: In a cohort of HIV-infected patients, syphilis reinfection was established both clinically and biologically by evaluating changes in Venereal Disease Research Laboratory titers. Photographs and medical records were studied in order to determine the type of skin lesions and their quantification.

Results: Among 533 HIV-infected patients, 42 (8%) experienced a first syphilis infection. Thirteen episodes of reinfection occurred in 12/42 (28%) patients, all MSM. In 78% of cases, reinfections were less symptomatic than first episodes. All patients presented classical syphilis lesions.

Conclusions: We observed a high rate of reinfection, but with less severe skin manifestations during reinfection episodes.