Evaluation of syphilis in patients with HIV infection in Nigeria
Tropical Medicine and International Health
Department of Dermatology, Univ. of Nigeria Teaching Hospital, Enugu, Nigeria; Department of Chemical Pathology, Univ. of Nigeria Teaching Hospital, Enugu, Nigeria; Department of Dermatology, College of Medicine, Univ. of Nigeria Teaching Hospital, PMB 01
OBJECTIVE: To document the manifestations of syphilis among patients with concurrent HIV infection over a 12-month period. METHOD: Descriptive, cross-sectional, hospital-based study of all adult patients with syphilis and HIV infection who attended the skin clinic of the University of Nigeria, Teaching Hospital, Enugu, between July 2000 and June 2001. A standardized questionnaire was used to record age, sex, marital status, occupation and risk factor for HIV infection; initial site of onset of rash/ulcers, duration of the illness, any concomitant affection of mucosa, hair and nails as well as treatments received by each patient prior to presentation. Morphological distribution of lesions, mucosal surface (conjuctival, vulval and rectal) examinations and documentation of concomitant disorders with HIV were noted by the examining dermatologist. Lesional biopsy and dark-field microscopy were undertaken to confirm diagnosis where serologic (non-treponemal and treponemal specific) tests for syphilis were inconsistent with clinical suspicion. Each patient had a routine chest x-ray, mantoux and purified protein derivative (PPD) status taken. RESULTS: Thirty-one patients (21 males) with concurrent syphilis and HIV were seen during the study period. Primary syphilis was diagnosed in nine (29%), secondary syphilis in 20 (64.5%) and latent syphilis in two (6.5%). Neurosyphilis was not observed. Prevalence of syphilis for these patients with concurrent HIV was 2.1%. Mean duration of syphilis was 3.9 months ± 1.4 and lesions of greatest concern occurred mainly on the genitalia. The glans penis was affected in 10 (32.3%) cases, the penile shaft in seven (22.6%), the oral cavity in five (16.1%), the rectum in six (19.4%) and the vulva in three (0.9%) cases. Nine (29.1%) patients had a history of primary syphilitic chancre, 19 (61.3%) had a past history of sexually transmitted disease (STD) - particularly genital ulcers - while three (9.7%) could not recall any past history of STD. Eighteen (59.3%) had a history of unprotected sex, 16 (51.7%) had multiple sexual partners, four (13.3%) had had oral sex, and one anal sex (3.3%); none admitted to being bisexual. Other relevant risk factors for HIV transmission were blood transfusion within 5 years for three (9.7%) and intravenous drug use in two (6.5%). Some patients had more than one condition as a potential source of exposure. Serological tests were weakly reactive in 17 (48.4%), strongly reactive in nine (29%) and non-reactive in five (16.1%) patients. Three patients exhibited prozone phenomenon. Treatment comprised the syndromic approach, which currently is advocated for use in primary healthcare centres without facilities for aetiological diagnosis of sexually transmitted infections. CONCLUSION: Our cases with concurrent syphilis and HIV/AIDS had unusual manifestations, responded to treatment more slowly and died sooner than cases described in Western literature due to generally lower levels of health.
benzathine penicillin; tuberculin; disease prevalence; disease transmission; human immunodeficiency virus; syphilis; adolescent; adult; article; biopsy; bisexuality; blood transfusion; clinical article; clinical feature; comorbidity; controlled study; disease association; disease duration; disease severity; female; fluorescent treponema antibody test; genital system disease; genital ulcer; hair disease; health care facility; health center; human; Human immunodeficiency virus infection; intravenous drug abuse; male; medical documentation; microscopy; mortality; mouth cavity; mouth inflammation; mucosa inflammation; nail disease; neurosyphilis; Nigeria; penis glans; physical examination; prevalence; primary health care; questionnaire; rash; recall; rectum disease; risk factor; safe sex; serodiagnosis; serology; sexual behavior; sexually transmitted disease; skin ulcer; syphilis; teaching hospital; thorax radiography; Treponema pallidum; tuberculin test; unprotected sex; venereal disease reaction test; vulva disease; Adolescent; Adult; Anti-Bacterial Agents; Chancre; Cross-Sectional Studies; Developing Countries; Female; HIV Infections; Humans; Male; Middle Aged; Nigeria; Penicillin G, Benzathine; Risk Factors; Sexual Behavior; Syphilis; Treatment Outcome; Africa; Eastern Hemisphere; Nigeria; Sub-Saharan Africa; West Africa; World; Glans; Human immunodeficiency virus; RNA viruses; Treponema; Treponema pallidum