Syphilis Infection in HIV Positive Individuals


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The contraction of a syphilis infection if you are a HIV positive person is far more serious compared with someone who is not HIV positive. There is believed to be a complex interaction between HIV and the bacteria that causes syphilis. It is well documented that having syphilis may render you more vulnerable to contracting HIV. More research suggests however that in some individuals that have HIV before getting syphilis, the way in which syphilis progresses is affected. One example of such change is where there is more rapid progression between the primary and secondary stage, so much so that the symptoms associated commonly with the secondary stage begin to overlap with those experienced in the primary stage.  Often, more lesions are seen in individuals who have both infections present and these can be deeper than average.

Having HIV dramatically compromises the immune system in positive patients, a syndrome known as AIDS. This means that the individual is less able to make an immune response to invading pathogens, such as bacteria, therefore more susceptible to the onset of infection. This increases the chance of all infections occurring, including syphilis.

Diagnosing syphilis in HIV infected people

Diagnosing syphilis in individuals with a pre-existing HIV infection is more difficult than in patents that are clear of HIV. Symptoms experienced within people with HIV are atypical compared to the normal clinical presentation therefore clinicians may not initially suspect syphilis as the cause. In addition, some results from screens for the bacteria, T pallidum, that causes syphilis may come back as false negative despite syphilis being present, or false positive even if clear of syphilis. Serological tests do seem to be accurate for the majority of individuals but there should always be a second method of analysis performed to ensure correct diagnosis.  If legions are present, a swab analysis should be taken and then both tests combined along with a medical history and detailed records of symptoms experienced will enable a reliable diagnosis.

The drugs used to treat syphilis in people with HIV are the same as those used to treat people without HIV. Penicillin G is injected intramuscularly, although the amount of injects required may be more than the average patient due to the weakened immune system. Side effects can occur slightly more commonly if you have HIV, especially the possibility of experiencing the Harisch-Herxheimer reaction.  Regular follow ups are essential to ensure treatment has been successful. There should be full re-tests for syphilis infection at 3, 6, 9, 12, and 24 months after initial treatment has occurred and if any further treatment is required this will be done straight away.

How can the risk of getting syphilis be reduced?

If you are HIV positive, it is highly recommended that you have regular screenings for all STIs, including syphilis. In addition it is essential that you only have protected sexual intercourse, not just to prevent contracting syphilis but also to prevent the spreading of HIV to other individuals. If you have had sexual contact with anyone up to three months prior to discovering a syphilis infection, it is vital that all individuals are informed to get themselves tested for STIs.


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