Human immunodeficiency virus-infected men who have sex with men with syphilis: A 5-year multicentre study in Malaysia

• Main Authors: Ong, Siaw Yen, Tang, Min Moon, Dalawi, Izzaty, Tan, Wooi Chiang, Yeoh, Chin Aun, Kho, Wee Men, Muniandy, Pubalan, Wong, Pui Li, Velayuthan, Rukumani Devi, Kwan, Zhenli, Ch'ng, Chin Chwen, Mohd Noor, Norli Marwyne, Krishnasamy, Vijayaletchumi, Johar, Asmah
• Format: Article
• Published: Malaysian Medical Association 2020
• Subjects: R Medicine
• Online Access: http://eprints.um.edu.my/25451/; http://www.e-mjm.org/2020/v75n4/sexually-transmitted-infections.pdf
• Institution: Universiti Malaya

Objectives: High rates of syphilis have been reported worldwide among men who have sex with men (MSM). This study aims to describe the clinical pattern and treatment response of syphilis among human immunodeficiency virus (HIV)-infected MSM in Malaysia. Methods: This is a retrospective study on all HIV-infected MSM with syphilis between 2011 and 2015. Data was collected from case notes in five centres namely Hospital Kuala Lumpur, Hospital Sultanah Bahiyah, Hospital Umum Sarawak, University of Malaya Medical Centre and Hospital Sungai Buloh. Results: A total of 294 HIV seropositive MSM with the median age of 29 years (range 16-66) were confirmed to have syphilis. Nearly half (47.6%) were in the age group of 20-29 years. About a quarter (24.1%) was previously infected with syphilis. Eighty-three patients (28.2%) had other concomitant sexually transmitted infection with genital warts being the most frequently reported (17%). The number of patients with early and late syphilis in our cohort were almost equal. The median pre-treatment non-treponemal antibody titre (VDRL or RPR) for early syphilis (1:64) was significantly higher than for late syphilis (1:8) (p<0.0001). The median CD4 count and the number of patients with CD4 <200/μl in early syphilis were comparable to late syphilis. Nearly four-fifth (78.9%) received benzathine-penicillin only, 5.8% doxycycline, 1.4% C-penicillin, 1% procaine penicillin, and 12.4% a combination of the above medications. About 44% received treatment and were lost to follow-up. Among those who completed 1-year follow-up after treatment, 72.3% responded to treatment (serological non-reactive – 18.2%, four-fold drop in titre – 10.9%; serofast – 43.6%), 8.5% failed treatment and 17% had re-infection. Excluding those who were re-infected, lost to follow-up and died, the rates of treatment failure were 12.1% and 8.8% for early and late syphilis respectively (p=0.582). Conclusion: The most common stage of syphilis among MSM with HIV was latent syphilis. Overall, about 8.5% failed treatment at 1-year follow-up. © 2020, Malaysian Medical Association. All rights reserved.