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Syphilis and HIV are often found in association with one another, suggesting that syphilitic genital ulcers increase the risk of HIV transmission. In addition, HIV-infected patients with syphilis seem to be at greater risk for florid clinical syphilis and may be more prone to treatment failure and development of neurologic complications than HIV-negative patients. Recent studies in HIV-positive patients with syphilis have demonstrated no treatment failures, however, despite slower serologic responses with standard therapy. Both nontreponemal and treponemal serologic tests for syphilis are generally reliable in most patients with HIV and can be used and interpreted in the usual way.

The recommended treatment regimens for HIV-infected patients do not differ from those recommended for HIV-negative patients, although some experts advocate more vigorous and prolonged treatment in the setting of HIV co-infection to prevent neurologic complications. In either case, more frequent follow-up to ensure treatment response is recommended. All patients with either late latent syphilis or syphilis of unknown duration should have a CSF examination before treatment.

The efficacy of non-penicillin regimens in HIV-infected patients has not been well studied, so penicillin is recommended for use whenever possible.


Men's Health