Recommendations for Diagnosing and Treating Syphilis in HIV-Infected Patients
THE CLINICAL manifestations, serologic responses, efficacy of treatment, and occurrence of complications of syphilis may be altered in patients coinfected with human immunodeficiency virus (HIV). Because syphilis is a disease with a broad range of manifestations and variable course, assessing reports of unusual clinical or laboratory findings in HIV-coinfected patients is difficult.1 On March 21 and 22,1988, experts* from academic medical centers and state and local health departments met at CDC to discuss the diagnosis and treatment of syphilis in HIV-infected patients. The following recommendations were developed based on these discussions.
DIAGNOSIS OF SYPHILIS IN HIV-INFECTED PATIENTS
Most HIV-infected patients appear to have a normal serologic response in Treponema pallidum infection.2 However, in some HIV-infected patients with biopsy-confirmed secondary syphilis, both nontreponemal and treponemal tests for syphilis are negative.3 In addition, some patients infected with both T. pallidum and HIV have had unusually high titers on nontreponemal serologic